Cooperative operation of robotic arms

ABSTRACT

A robotic surgical system for treating a patient comprises a first robotic arm configured to remotely control a surgical instrument that is positionable within a cavity of the patient; a second robotic arm configured to remotely control a device that is passable through an orifice of the patient; and a control circuit communicatively couplable to the first and second robotic arm. The first and second robotic are each attached to a surgical platform. The control circuit is configured to determine a position of the arms; cause each of the first and second robotic arm to change their respective position and orientation based on an adjustment of a platform position of the surgical platform; and control the first robotic arm and the second robotic arm to cooperatively interact to perform a surgical operation.

BACKGROUND

The present disclosure relates to robotic surgical systems. Roboticsurgical systems can include a central control unit, a surgeon's commandconsole, and a robot having one or more robotic arms. Robotic surgicaltools can be releasably mounted to the robotic arm(s). The number andtype of robotic surgical tools can depend on the type of surgicalprocedure. Robotic surgical systems can be used in connection with oneor more displays and/or one or more handheld surgical instruments duringa surgical procedure.

FIGURES

The features of various aspects are set forth with particularity in theappended claims. The various aspects, however, both as to organizationand methods of operation, together with further objects and advantagesthereof, may best be understood by reference to the followingdescription, taken in conjunction with the accompanying drawings asfollows.

FIG. 1 is a block diagram of a computer-implemented interactive surgicalsystem, in accordance with at least one aspect of the presentdisclosure.

FIG. 2 is a surgical system being used to perform a surgical procedurein an operating room, in accordance with at least one aspect of thepresent disclosure.

FIG. 3 is a surgical hub paired with a visualization system, a roboticsystem, and an intelligent instrument, in accordance with at least oneaspect of the present disclosure.

FIG. 4 is a schematic of a robotic surgical system, in accordance withat least one aspect of the present disclosure.

FIG. 4A illustrates another exemplification of a robotic arm and anotherexemplification of a tool assembly releasably coupled to the roboticarm, according to one aspect of the present disclosure.

FIG. 5 is a block diagram of control components for the robotic surgicalsystem of FIG. 4 , in accordance with at least one aspect of the presentdisclosure.

FIG. 6 is a schematic of a robotic surgical system during a surgicalprocedure including a plurality of hubs and interactive secondarydisplays, in accordance with at least one aspect of the presentdisclosure.

FIG. 7 is a detail view of the interactive secondary displays of FIG. 6, in accordance with at least one aspect of the present disclosure.

FIG. 8 illustrates a surgical data network comprising a modularcommunication hub configured to connect modular devices located in oneor more operating theaters of a healthcare facility, or any room in ahealthcare facility specially equipped for surgical operations, to thecloud, in accordance with at least one aspect of the present disclosure.

FIG. 9 illustrates a computer-implemented interactive surgical system,in accordance with at least one aspect of the present disclosure.

FIG. 10 illustrates a surgical hub comprising a plurality of modulescoupled to the modular control tower, in accordance with at least oneaspect of the present disclosure.

FIG. 11 illustrates one aspect of a Universal Serial Bus (USB) networkhub device, in accordance with at least one aspect of the presentdisclosure.

FIG. 12 illustrates a logic diagram of a control system of a surgicalinstrument or tool, in accordance with at least one aspect of thepresent disclosure.

FIG. 13 illustrates a control circuit configured to control aspects ofthe surgical instrument or tool, in accordance with at least one aspectof the present disclosure.

FIG. 14 illustrates a combinational logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 15 illustrates a sequential logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions, inaccordance with at least one aspect of the present disclosure.

FIG. 17 is a schematic diagram of a robotic surgical instrumentconfigured to operate a surgical tool described herein, in accordancewith at least one aspect of the present disclosure.

FIG. 18 illustrates a block diagram of a surgical instrument programmedto control the distal translation of a displacement member, inaccordance with at least one aspect of the present disclosure.

FIG. 19 is a schematic diagram of a surgical instrument configured tocontrol various functions, in accordance with at least one aspect of thepresent disclosure.

FIG. 20 is a simplified block diagram of a generator configured toprovide inductorless tuning, among other benefits, in accordance with atleast one aspect of the present disclosure.

FIG. 21 illustrates an example of a generator, which is one form of thegenerator of FIG. 20 , in accordance with at least one aspect of thepresent disclosure.

FIG. 22 is a schematic of a robotic surgical system, in accordance withone aspect of the present disclosure.

FIG. 23 is a side, perspective view of a surgical assembly including asurgical instrument holder, an instrument drive unit (IDU), an adapterassembly, and a surgical instrument, in accordance with at least oneaspect of the present disclosure.

FIG. 24 is a side view of an arm that may be included in a roboticsurgical system in an open position, in accordance with at least oneaspect of the present disclosure.

FIG. 25 is a front perspective view of a robotic arm of a roboticsurgical assembly including an IDU holder, in accordance with at leastone aspect of the present disclosure.

FIG. 26 is a perspective view of an arm of an medical work stationincluding a mounting structure thereon, in accordance with at least oneaspect of the present disclosure.

FIG. 27 is a block diagram of control components for controlling arobotic surgical system, in accordance with at least one aspect of thepresent disclosure.

FIG. 28 is a perspective view of a torque sensor assembly for use withthe robotic arm, in accordance with at least one aspect of the presentdisclosure.

FIG. 29 is a perspective view of a torque sensor assembly for use with arobotic arm, in accordance with at least one aspect of the presentdisclosure.

FIGS. 30A-30C are diagrams of a remote center of motion (RCM) roboticmodule, in accordance with at least one aspect of the presentdisclosure.

FIG. 31 shows motion about a remote center of motion (RCM) afteradjusting the RCM, in accordance with at least one aspect of the presentdisclosure.

FIG. 32 is a perspective view of a surgical robotic arm of a roboticsystem, in accordance with at least one aspect of the presentdisclosure.

FIG. 33 is a top view of a surgical environment including a patientbeing treated by a robotic surgical assembly, in accordance with atleast one aspect of the present disclosure.

FIGS. 34A-34B are top views of a surgical environment including apatient being treated by a robotic surgical assembly, in accordance withat least one aspect of the present disclosure.

FIG. 35 is a diagram of a trocar port placement configuration, inaccordance with at least one aspect of the present disclosure.

FIGS. 36A-36B illustrates operation in a lower quadrant for a loweranterior resection procedure, in accordance with at least one aspect ofthe present disclosure.

FIG. 37 illustrates positioning of a transected colon portion relativeto a rectal portion of a patient for connection of an anvil to acircular stapler surgical instrument, in accordance with at least oneaspect of the present disclosure.

FIGS. 38A-38B depict the use of multiple surgical implements held bycorresponding robotic arms to mobilize the colon of a patient and toperform anastomosis, respectively, in accordance with at least oneaspect of the present disclosure.

FIG. 39 is an exploded view of a surgical mounting device, in accordancewith at least one aspect of the present disclosure.

FIG. 40 is a perspective view of an embodiment of a clamping assembly ofthe mounting device of FIG. 39 , in accordance with at least one aspectof the present disclosure.

FIG. 41A is a perspective view of the mounting device of FIG. 39 , withthe clamping assembly in an unlocked configuration, for receipt of anaccess device therein, in accordance with at least one aspect of thepresent disclosure.

FIG. 41B is a perspective view of the mounting device of FIG. 39 , withthe clamping assembly in a locked configuration, and with the accessdevice secured therein, in accordance with at least one aspect of thepresent disclosure.

FIGS. 42A-42D depict various detections of magnetic signatures ofcorrelated field magnets located on a trocar by a Hall effect sensor, inaccordance with at least one aspect of the present disclosure.

FIGS. 43A-43E depict various detections of magnetic signatures ofcorrelated field magnets located on a trocar by a Hall effect sensor, inaccordance with at least one aspect of the present disclosure.

FIGS. 44A-44C depict various detections of visual cues by opticalsensing means, in accordance with at least one aspect of the presentdisclosure.

FIG. 45 is a bottom perspective view of a cannula including an array ofplural magnet positions, in accordance with at least one aspect of thepresent disclosure.

FIGS. 46A-46B depict the management of an insufflation tubing used inconjunction with a robotic arm within a sterile barrier, in accordancewith at least one aspect of the present disclosure.

FIG. 47 shows a sealing system and reprocessable control housing for usewith a cannula and insufflation valve, in accordance with at least oneaspect of the present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. PatentApplications, filed on Jun. 27, 2019, the disclosure of each of which isherein incorporated by reference in its entirety:

-   U.S. patent application Ser. No. 16/454,702, titled METHOD OF USING    A SURGICAL MODULAR ROBOTIC ASSEMBLY, now U.S. Pat. No. 11,369,443;-   U.S. patent application Ser. No. 16/454,710, titled SURGICAL SYSTEMS    WITH INTERCHANGEABLE MOTOR PACKS, now U.S. Pat. No. 11,013,569-   U.S. patent application Ser. No. 16/454,715, titled COOPERATIVE    ROBOTIC SURGICAL SYSTEMS, now U.S. Patent Application Publication    No. 2020/0405404;-   U.S. patent application Ser. No. 16/454,740, titled HEAT EXCHANGE    SYSTEMS FOR ROBOTIC SURGICAL SYSTEMS, now U.S. Patent Application    Publication No. 2020/0405415-   U.S. patent application Ser. No. 16/454,757, titled DETERMINING    ROBOTIC SURGICAL ASSEMBLY COUPLING STATUS, now U.S. Pat. No.    11,376,083:-   U.S. patent application Ser. No. 14/454,780, titled ROBOTIC SURGICAL    ASSEMBLY COUPLING SAFETY MECHANISMS, now U.S. Patent Application    Publication No. 2020/0405408;-   U.S. patent application Ser. No. 16/454,707, titled ROBOTIC SURGICAL    SYSTEM WITH SAFETY AND COOPERATIVE SENSING CONTROL, now U.S. Pat.    No. 11,547,468;-   U.S. patent application Ser. No. 16/454,726, titled ROBOTIC ROBOTIC    SURGICAL SYSTEM FOR CONTROLLING CLOSE OPERATION OF END-EFFECTORS,    now U.S. Pat. No. 11,399,906;-   U.S. patent application Ser. No. 14/454,737, titled ROBOTIC SURGICAL    SYSTEM WITH LOCAL SENSING OF FUNCTIONAL PARAMETERS BASED ON    MEASUREMENTS OF MULTIPLE PHYSICAL INPUTS, now U.S. Pat. No.    11,376,082:-   U.S. patent application Ser. No. 16/454,760, titled SURGICAL    INSTRUMENT DRIVE SYSTEMS, now U.S. Pat. No. 11,278,362:-   U.S. patent application Ser. No. 16/454,769, titled SURGICAL    INSTRUMENT DRIVE SYSTEMS WITH CABLE-TIGHTENING SYSTEM, now U.S. Pat.    No. 11,207,146:-   U.S. patent application Ser. No. 16/454,727, titled VISUALIZATION    SYSTEM WITH AUTOMATIC CONTAMINATION DETECTION AND CLEANING CONTROLS,    now U.S. Patent Application Publication No. 2020/0405401; and-   U.S. patent application Ser. No. 16/454,741, titled MULTI-ACCESS    PORT FOR SURGICAL ROBOTIC SYSTEMS, now U.S. Pat. No. 11,413,102.

Applicant of the present application owns the following U.S. patentapplications, filed on Dec. 4, 2018, the disclosure of each of which isherein incorporated by reference in its entirety:

-   U.S. patent application Ser. No. 16/209,385, titled METHOD OF HUB    COMMUNICATION, PROCESSING, STORAGE AND DISPLAY;-   U.S. patent application Ser. No. 16/209,395, titled METHOD OF HUB    COMMUNICATION;-   U.S. patent application Ser. No. 16/209,403, titled METHOD OF CLOUD    BASED DATA ANALYTICS FOR USE WITH THE HUB;-   U.S. patent application Ser. No. 16/209,407, titled METHOD OF    ROBOTIC HUB COMMUNICATION, DETECTION, AND CONTROL;-   U.S. patent application Ser. No. 16/209,416, titled METHOD OF HUB    COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS;-   U.S. patent application Ser. No. 16/209,423, titled METHOD OF    COMPRESSING TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY    DISPLAYING THE LOCATION OF THE TISSUE WITHIN THE JAWS;-   U.S. patent application Ser. No. 16/209,427, titled METHOD OF USING    REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZE    PERFORMANCE OF RADIO FREQUENCY DEVICES;-   U.S. patent application Ser. No. 16/209,433, titled METHOD OF    SENSING PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING    THE PUMP SPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING    THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB;-   U.S. patent application Ser. No. 16/209,447, titled METHOD FOR SMOKE    EVACUATION FOR SURGICAL HUB;-   U.S. patent application Ser. No. 16/209,453, titled METHOD FOR    CONTROLLING SMART ENERGY DEVICES;-   U.S. patent application Ser. No. 16/209,458, titled METHOD FOR SMART    ENERGY DEVICE INFRASTRUCTURE;-   U.S. patent application Ser. No. 16/209,465, titled METHOD FOR    ADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND    INTERACTION;-   U.S. patent application Ser. No. 16/209,478, titled METHOD FOR    SITUATIONAL AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK    CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED    SITUATION OR USAGE;-   U.S. patent application Ser. No. 16/209,490, titled METHOD FOR    FACILITY DATA COLLECTION AND INTERPRETATION; and-   U.S. patent application Ser. No. 16/209,491, titled METHOD FOR    CIRCULAR STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL    AWARENESS.

Before explaining various aspects of surgical devices and generators indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects and/or examples.

Referring to FIG. 1 , a computer-implemented interactive surgical system100 includes one or more surgical systems 102 and a cloud-based system(e.g., the cloud 104 that may include a remote server 113 coupled to astorage device 105). Each surgical system 102 includes at least onesurgical hub 106 in communication with the cloud 104 that may include aremote server 113. In one example, as illustrated in FIG. 1 , thesurgical system 102 includes a visualization system 108, a roboticsystem 110, and a handheld intelligent surgical instrument 112, whichare configured to communicate with one another and/or the hub 106. Insome aspects, a surgical system 102 may include an M number of hubs 106,an N number of visualization systems 108, an O number of robotic systems110, and a P number of handheld intelligent surgical instruments 112,where M, N, O, and P are integers greater than or equal to one.

FIG. 3 depicts an example of a surgical system 102 being used to performa surgical procedure on a patient who is lying down on an operatingtable 114 in a surgical operating room 116. A robotic system 110 is usedin the surgical procedure as a part of the surgical system 102. Therobotic system 110 includes a surgeon's console 118, a patient side cart120 (surgical robot), and a surgical robotic hub 122. The patient sidecart 120 can manipulate at least one removably coupled surgical tool 117through a minimally invasive incision in the body of the patient whilethe surgeon views the surgical site through the surgeon's console 118.An image of the surgical site can be obtained by a medical imagingdevice 124, which can be manipulated by the patient side cart 120 toorient the imaging device 124. The robotic hub 122 can be used toprocess the images of the surgical site for subsequent display to thesurgeon through the surgeon's console 118.

Other types of robotic systems can be readily adapted for use with thesurgical system 102. Various examples of robotic systems and surgicaltools that are suitable for use with the present disclosure aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,339,titled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

Various examples of cloud-based analytics that are performed by thecloud 104, and are suitable for use with the present disclosure, aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,340,titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

In various aspects, the imaging device 124 includes at least one imagesensor and one or more optical components. Suitable image sensorsinclude, but are not limited to, Charge-Coupled Device (CCD) sensors andComplementary Metal-Oxide Semiconductor (CMOS) sensors.

The optical components of the imaging device 124 may include one or moreillumination sources and/or one or more lenses. The one or moreillumination sources may be directed to illuminate portions of thesurgical field. The one or more image sensors may receive lightreflected or refracted from the surgical field, including lightreflected or refracted from tissue and/or surgical instruments.

The one or more illumination sources may be configured to radiateelectromagnetic energy in the visible spectrum as well as the invisiblespectrum. The visible spectrum, sometimes referred to as the opticalspectrum or luminous spectrum, is that portion of the electromagneticspectrum that is visible to (i.e., can be detected by) the human eye andmay be referred to as visible light or simply light. A typical human eyewill respond to wavelengths in air that are from about 380 nm to about750 nm.

The invisible spectrum (i.e., the non-luminous spectrum) is that portionof the electromagnetic spectrum that lies below and above the visiblespectrum (i.e., wavelengths below about 380 nm and above about 750 nm).The invisible spectrum is not detectable by the human eye. Wavelengthsgreater than about 750 nm are longer than the red visible spectrum, andthey become invisible infrared (IR), microwave, and radioelectromagnetic radiation. Wavelengths less than about 380 nm areshorter than the violet spectrum, and they become invisible ultraviolet,x-ray, and gamma ray electromagnetic radiation.

In various aspects, the imaging device 124 is configured for use in aminimally invasive procedure. Examples of imaging devices suitable foruse with the present disclosure include, but not limited to, anarthroscope, angioscope, bronchoscope, choledochoscope, colonoscope,cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope(gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope,sigmoidoscope, thoracoscope, and ureteroscope.

In one aspect, the imaging device employs multi-spectrum monitoring todiscriminate topography and underlying structures. A multi-spectralimage is one that captures image data within specific wavelength rangesacross the electromagnetic spectrum. The wavelengths may be separated byfilters or by the use of instruments that are sensitive to particularwavelengths, including light from frequencies beyond the visible lightrange, e.g., IR and ultraviolet. Spectral imaging can allow extractionof additional information the human eye fails to capture with itsreceptors for red, green, and blue. The use of multi-spectral imaging isdescribed in greater detail under the heading “Advanced ImagingAcquisition Module” in U.S. Provisional Patent Application Ser. No.62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety. Multi-spectrum monitoring can be a useful tool in relocating asurgical field after a surgical task is completed to perform one or moreof the previously described tests on the treated tissue.

It is axiomatic that strict sterilization of the operating room andsurgical equipment is required during any surgery. The strict hygieneand sterilization conditions required in a “surgical theater,” i.e., anoperating or treatment room, necessitate the highest possible sterilityof all medical devices and equipment. Part of that sterilization processis the need to sterilize anything that comes in contact with the patientor penetrates the sterile field, including the imaging device 124 andits attachments and components. It will be appreciated that the sterilefield may be considered a specified area, such as within a tray or on asterile towel, that is considered free of microorganisms, or the sterilefield may be considered an area, immediately around a patient, who hasbeen prepared for a surgical procedure. The sterile field may includethe scrubbed team members, who are properly attired, and all furnitureand fixtures in the area.

In various aspects, the visualization system 108 includes one or moreimaging sensors, one or more image processing units, one or more storagearrays, and one or more displays that are strategically arranged withrespect to the sterile field, as illustrated in FIG. 2 . In one aspect,the visualization system 108 includes an interface for HL7, PACS, andEMR. Various components of the visualization system 108 are describedunder the heading “Advanced Imaging Acquisition Module” in U.S.Provisional Patent Application Ser. No. 62/611,341, titled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which isherein incorporated by reference in its entirety.

As illustrated in FIG. 2 , a primary display 119 is positioned in thesterile field to be visible to an operator at the operating table 114.In addition, a visualization tower 111 is positioned outside the sterilefield. The visualization tower 111 includes a first non-sterile display107 and a second non-sterile display 109, which face away from eachother. The visualization system 108, guided by the hub 106, isconfigured to utilize the displays 107, 109, and 119 to coordinateinformation flow to operators inside and outside the sterile field. Forexample, the hub 106 may cause the visualization system 108 to display asnap-shot of a surgical site, as recorded by an imaging device 124, on anon-sterile display 107 or 109, while maintaining a live feed of thesurgical site on the primary display 119. The snap-shot on thenon-sterile display 107 or 109 can permit a non-sterile operator toperform a diagnostic step relevant to the surgical procedure, forexample.

In one aspect, the hub 106 is also configured to route a diagnosticinput or feedback entered by a non-sterile operator at the visualizationtower 111 to the primary display 119 within the sterile field, where itcan be viewed by a sterile operator at the operating table. In oneexample, the input can be in the form of a modification to the snap-shotdisplayed on the non-sterile display 107 or 109, which can be routed tothe primary display 119 by the hub 106.

Referring to FIG. 2 , a surgical instrument 112 is being used in thesurgical procedure as part of the surgical system 102. The hub 106 isalso configured to coordinate information flow to a display of thesurgical instrument 112. For example, in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, the disclosure of which is herein incorporated byreference in its entirety. A diagnostic input or feedback entered by anon-sterile operator at the visualization tower 111 can be routed by thehub 106 to the surgical instrument display 115 within the sterile field,where it can be viewed by the operator of the surgical instrument 112.Example surgical instruments that are suitable for use with the surgicalsystem 102 are described under the heading “Surgical InstrumentHardware” and in U.S. Provisional Patent Application Ser. No.62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety, for example.

Referring now to FIG. 3 , a hub 106 is depicted in communication with avisualization system 108, a robotic system 110, and a handheldintelligent surgical instrument 112. The hub 106 includes a hub display135, an imaging module 138, a generator module 140, a communicationmodule 130, a processor module 132, and a storage array 134. In certainaspects, as illustrated in FIG. 3 , the hub 106 further includes a smokeevacuation module 126 and/or a suction/irrigation module 128.

During a surgical procedure, energy application to tissue, for sealingand/or cutting, is generally associated with smoke evacuation, suctionof excess fluid, and/or irrigation of the tissue. Fluid, power, and/ordata lines from different sources are often entangled during thesurgical procedure. Valuable time can be lost addressing this issueduring a surgical procedure. Detangling the lines may necessitatedisconnecting the lines from their respective modules, which may requireresetting the modules. The hub modular enclosure 136 offers a unifiedenvironment for managing the power, data, and fluid lines, which reducesthe frequency of entanglement between such lines.

Aspects of the present disclosure present a surgical hub for use in asurgical procedure that involves energy application to tissue at asurgical site. The surgical hub includes a hub enclosure and a combogenerator module slidably receivable in a docking station of the hubenclosure. The docking station includes data and power contacts. Thecombo generator module includes two or more of an ultrasonic energygenerator component, a bipolar RF energy generator component, and amonopolar RF energy generator component that are housed in a singleunit. In one aspect, the combo generator module also includes a smokeevacuation component, at least one energy delivery cable for connectingthe combo generator module to a surgical instrument, at least one smokeevacuation component configured to evacuate smoke, fluid, and/orparticulates generated by the application of therapeutic energy to thetissue, and a fluid line extending from the remote surgical site to thesmoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluidline extends from the remote surgical site to a suction and irrigationmodule slidably received in the hub enclosure. In one aspect, the hubenclosure comprises a fluid interface.

Certain surgical procedures may require the application of more than oneenergy type to the tissue. One energy type may be more beneficial forcutting the tissue, while another different energy type may be morebeneficial for sealing the tissue. For example, a bipolar generator canbe used to seal the tissue while an ultrasonic generator can be used tocut the sealed tissue. Aspects of the present disclosure present asolution where a hub modular enclosure 136 is configured to accommodatedifferent generators, and facilitate an interactive communicationtherebetween. One of the advantages of the hub modular enclosure 136 isenabling the quick removal and/or replacement of various modules.

Aspects of the present disclosure present a modular surgical enclosurefor use in a surgical procedure that involves energy application totissue. The modular surgical enclosure includes a first energy-generatormodule, configured to generate a first energy for application to thetissue, and a first docking station comprising a first docking port thatincludes first data and power contacts, wherein the firstenergy-generator module is slidably movable into an electricalengagement with the power and data contacts and wherein the firstenergy-generator module is slidably movable out of the electricalengagement with the first power and data contacts,

Further to the above, the modular surgical enclosure also includes asecond energy-generator module configured to generate a second energy,different than the first energy, for application to the tissue, and asecond docking station comprising a second docking port that includessecond data and power contacts, wherein the second energy-generatormodule is slidably movable into an electrical engagement with the powerand data contacts, and wherein the second energy-generator module isslidably movable out of the electrical engagement with the second powerand data contacts.

In addition, the modular surgical enclosure also includes acommunication bus between the first docking port and the second dockingport, configured to facilitate communication between the firstenergy-generator module and the second energy-generator module.

Referring to FIG. 3 , aspects of the present disclosure are presentedfor a hub modular enclosure 136 that allows the modular integration of agenerator module 140, a smoke evacuation module 126, and asuction/irrigation module 128. The hub modular enclosure 136 furtherfacilitates interactive communication between the modules 140, 126, 128.The generator module 140 can be a generator module with integratedmonopolar, bipolar, and ultrasonic components supported in a singlehousing unit slidably insertable into the hub modular enclosure 136. Invarious aspects, the hub modular enclosure 136 can be configured tofacilitate the insertion of multiple generators and interactivecommunication between the generators docked into the hub modularenclosure 136 so that the generators would act as a single generator.

In one aspect, the hub modular enclosure 136 comprises a modular powerand communication backplane with external and wireless communicationheaders to enable the removable attachment of the modules 140, 126, 128and interactive communication therebetween.

In various aspects, the imaging module 138 comprises an integrated videoprocessor and a modular light source and is adapted for use with variousimaging devices. In one aspect, the imaging device is comprised of amodular housing that can be assembled with a light source module and acamera module. The housing can be a disposable housing. In at least oneexample, the disposable housing is removably coupled to a reusablecontroller, a light source module, and a camera module. The light sourcemodule and/or the camera module can be selectively chosen depending onthe type of surgical procedure. In one aspect, the camera modulecomprises a CCD sensor. In another aspect, the camera module comprises aCMOS sensor. In another aspect, the camera module is configured forscanned beam imaging. Likewise, the light source module can beconfigured to deliver a white light or a different light, depending onthe surgical procedure.

During a surgical procedure, removing a surgical device from thesurgical field and replacing it with another surgical device thatincludes a different camera or a different light source can beinefficient. Temporarily losing sight of the surgical field may lead toundesirable consequences. The module imaging device of the presentdisclosure is configured to permit the replacement of a light sourcemodule or a camera module midstream during a surgical procedure, withouthaving to remove the imaging device from the surgical field.

In one aspect, the imaging device comprises a tubular housing thatincludes a plurality of channels. A first channel is configured toslidably receive the camera module, which can be configured for asnap-fit engagement with the first channel. A second channel isconfigured to slidably receive the light source module, which can beconfigured for a snap-fit engagement with the second channel. In anotherexample, the camera module and/or the light source module can be rotatedinto a final position within their respective channels. A threadedengagement can be employed in lieu of the snap-fit engagement.

In various examples, multiple imaging devices are placed at differentpositions in the surgical field to provide multiple views. The imagingmodule 138 can be configured to switch between the imaging devices toprovide an optimal view. In various aspects, the imaging module 138 canbe configured to integrate the images from the different imaging device.

Various image processors and imaging devices suitable for use with thepresent disclosure are described in U.S. Pat. No. 7,995,045, titledCOMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, which issued on Aug. 9,2011, which is herein incorporated by reference in its entirety. Inaddition, U.S. Pat. No. 7,982,776, titled SBI MOTION ARTIFACT REMOVALAPPARATUS AND METHOD, which issued on Jul. 19, 2011, which is hereinincorporated by reference in its entirety, describes various systems forremoving motion artifacts from image data. Such systems can beintegrated with the imaging module 138. Furthermore, U.S. PatentApplication Publication No. 2011/0306840, titled CONTROLLABLE MAGNETICSOURCE TO FIXTURE INTRACORPOREAL APPARATUS, which published on Dec. 15,2011, and U.S. Patent Application Publication No. 2014/0243597, titledSYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, whichpublished on Aug. 28, 2014, each of which is herein incorporated byreference in its entirety.

Robotic Surgical System

An example robotic surgical system is depicted in FIGS. 4 and 5 . Withreference to FIG. 4 , the robotic surgical system 13000 includes roboticarms 13002, 13003, a control device 13004, and a console 13005 coupledto the control device 13004. As illustrated in FIG. 4 , the surgicalsystem 13000 is configured for use on a patient 13013 lying on a patienttable 13012 for performance of a minimally invasive surgical operation.The console 13005 includes a display device 13006 and input devices13007, 13008. The display device 13006 is set up to displaythree-dimensional images, and the manual input devices 13007, 13008 areconfigured to allow a clinician to telemanipulate the robotic arms13002, 13003. Controls for a surgeon's console, such as the console13005, are further described in International Patent Publication No.WO2017/075121, filed Oct. 27, 2016, titled HAPTIC FEEDBACK FOR A ROBOTICSURGICAL SYSTEM INTERFACE, which is herein incorporated by reference inits entirety.

Each of the robotic arms 13002, 13003 is made up of a plurality ofmembers connected through joints and includes a surgical assembly 13010connected to a distal end of a corresponding robotic arm 13002, 13003.Support of multiple arms is further described in U.S. Patent ApplicationPublication No. 2017/0071693, filed Nov. 11, 2016, titled SURGICALROBOTIC ARM SUPPORT SYSTEMS AND METHODS OF USE, which is hereinincorporated by reference in its entirety. Various robotic armconfigurations are further described in International Patent PublicationNo. WO2017/044406, filed Sep. 6, 2016, titled ROBOTIC SURGICAL CONTROLSCHEME FOR MANIPULATING ROBOTIC END EFFECTORS, which is hereinincorporated by reference in its entirety. In an exemplification, thesurgical assembly 13010 includes a surgical instrument 13020 supportingan end effector 13023. Although two robotic arms 13002, 13003, aredepicted, the surgical system 13000 may include a single robotic arm ormore than two robotic arms 13002, 13003. Additional robotic arms arelikewise connected to the control device 13004 and are telemanipulatablevia the console 13005. Accordingly, one or more additional surgicalassemblies 13010 and/or surgical instruments 13020 may also be attachedto the additional robotic arm(s).

The robotic arms 13002, 13003 may be driven by electric drives that areconnected to the control device 13004. According to an exemplification,the control device 13004 is configured to activate drives, for example,via a computer program, such that the robotic arms 13002, 13003 and thesurgical assemblies 13010 and/or surgical instruments 13020corresponding to the robotic arms 13002, 13003, execute a desiredmovement received through the manual input devices 13007, 13008. Thecontrol device 13004 may also be configured to regulate movement of therobotic arms 13002, 13003 and/or of the drives.

The control device 13004 may control a plurality of motors (for example,Motor I . . . n) with each motor configured to drive a pushing or apulling of one or more cables, such as cables coupled to the endeffector 13023 of the surgical instrument 13020. In use, as these cablesare pushed and/or pulled, the one or more cables affect operation and/ormovement of the end effector 13023. The control device 13004 coordinatesthe activation of the various motors to coordinate a pushing or apulling motion of one or more cables in order to coordinate an operationand/or movement of one or more end effectors 13023. For example,articulation of an end effector by a robotic assembly such as thesurgical assembly 13010 is further described in U.S. Patent ApplicationPublication No. 2016/0303743, filed Jun. 6, 2016, titled WRIST AND JAWASSEMBLIES FOR ROBOTIC SURGICAL SYSTEMS and in International PatentPublication No. WO2016/144937, filed Mar. 8, 2016, titled MEASURINGHEALTH OF A CONNECTOR MEMBER OF A ROBOTIC SURGICAL SYSTEM, each of whichis herein incorporated by reference in its entirety. In anexemplification, each motor is configured to actuate a drive rod or alever arm to affect operation and/or movement of end effectors 13023 inaddition to, or instead of, one or more cables.

Driver configurations for surgical instruments, such as drivearrangements for a surgical end effector, are further described inInternational Patent Publication No. WO2016/183054, filed May 10, 2016,titled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC SURGICAL INSTRUMENT,International Patent Publication No. WO2016/205266, filed Jun. 15, 2016,titled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION SENSING,International Patent Publication No. WO2016/205452, filed Jun. 16, 2016,titled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITH BIDIRECTIONALCOUPLING, and International Patent Publication No. WO2017/053507, filedSep. 22, 2016, titled ELASTIC SURGICAL INTERFACE FOR ROBOTIC SURGICALSYSTEMS, each of which is herein incorporated by reference in itsentirety. The modular attachment of surgical instruments to a driver isfurther described in International Patent Publication No. WO2016/209769,filed Jun. 20, 2016, titled ROBOTIC SURGICAL ASSEMBLIES, which is hereinincorporated by reference in its entirety. Housing configurations for asurgical instrument driver and interface are further described inInternational Patent Publication No. WO2016/144998, filed Mar. 9, 2016,titled ROBOTIC SURGICAL SYSTEMS, INSTRUMENT DRIVE UNITS, AND DRIVEASSEMBLIES, which is herein incorporated by reference in its entirety.Various surgical instrument configurations for use with the robotic arms13002, 13003 are further described in International Patent PublicationNo. WO2017/053358, filed Sep. 21, 2016, titled SURGICAL ROBOTICASSEMBLIES AND INSTRUMENT ADAPTERS THEREOF and International PatentPublication No. WO2017/053363, filed Sep. 21, 2016, titled ROBOTICSURGICAL ASSEMBLIES AND INSTRUMENT DRIVE CONNECTORS THEREOF, each ofwhich is herein incorporated by reference in its entirety. Bipolarinstrument configurations for use with the robotic arms 13002, 13003 arefurther described in International Patent Publication No. WO2017/053698,filed Sep. 23, 2016, titled ROBOTIC SURGICAL ASSEMBLIES ANDELECTROMECHANICAL INSTRUMENTS THEREOF, which is herein incorporated byreference in its entirety. Shaft arrangements for use with the roboticarms 13002, 13003 are further described in International PatentPublication No. WO2017/116793, filed Dec. 19, 2016, titled ROBOTICSURGICAL SYSTEMS AND INSTRUMENT DRIVE ASSEMBLIES, which is hereinincorporated by reference in its entirety.

The control device 13004 includes any suitable logic control circuitadapted to perform calculations and/or operate according to a set ofinstructions. The control device 13004 can be configured to communicatewith a remote system “RS,” either via a wireless (e.g., Wi-Fi,Bluetooth, LTE, etc.) and/or wired connection. The remote system “RS”can include data, instructions and/or information related to the variouscomponents, algorithms, and/or operations of system 13000. The remotesystem “RS” can include any suitable electronic service, database,platform, cloud “C” (see FIG. 4 ), or the like. The control device 13004may include a central processing unit operably connected to memory. Thememory may include transitory type memory (e.g., RAM) and/ornon-transitory type memory (e.g., flash media, disk media, etc.). Insome exemplifications, the memory is part of, and/or operably coupledto, the remote system “RS.”

The control device 13004 can include a plurality of inputs and outputsfor interfacing with the components of the system 13000, such as througha driver circuit. The control device 13004 can be configured to receiveinput signals and/or generate output signals to control one or more ofthe various components (e.g., one or more motors) of the system 13000.The output signals can include, and/or can be based upon, algorithmicinstructions which may be pre-programmed and/or input by a user. Thecontrol device 13004 can be configured to accept a plurality of userinputs from a user interface (e.g., switches, buttons, touch screen,etc. of operating the console 13005) which may be coupled to remotesystem “RS.”

A memory 13014 can be directly and/or indirectly coupled to the controldevice 13004 to store instructions and/or databases includingpre-operative data from living being(s) and/or anatomical atlas(es). Thememory 13014 can be part of, and/or or operatively coupled to, remotesystem “RS.”

In accordance with an exemplification, the distal end of each roboticarm 13002, 13003 is configured to releasably secure the end effector13023 (or other surgical tool) therein and may be configured to receiveany number of surgical tools or instruments, such as a trocar orretractor, for example.

A simplified functional block diagram of a system architecture 13400 ofthe robotic surgical system 13010 is depicted in FIG. 5 . The systemarchitecture 13400 includes a core module 13420, a surgeon master module13430, a robotic arm module 13440, and an instrument module 13450. Thecore module 13420 serves as a central controller for the roboticsurgical system 13000 and coordinates operations of all of the othermodules 13430, 13440, 13450. For example, the core module 13420 mapscontrol devices to the arms 13002, 13003, determines current status,performs all kinematics and frame transformations, and relays resultingmovement commands. In this regard, the core module 13420 receives andanalyzes data from each of the other modules 13430, 13440, 13450 inorder to provide instructions or commands to the other modules 13430,13440, 13450 for execution within the robotic surgical system 13000.Although depicted as separate modules, one or more of the modules 13420,13430, 13440, and 13450 are a single component in otherexemplifications.

The core module 13420 includes models 13422, observers 13424, acollision manager 13426, controllers 13428, and a skeleton 13429. Themodels 13422 include units that provide abstracted representations (baseclasses) for controlled components, such as the motors (for example,Motor I . . . n) and/or the arms 13002, 13003. The observers 13424create state estimates based on input and output signals received fromthe other modules 13430, 13440, 13450. The collision manager 13426prevents collisions between components that have been registered withinthe system 13010. The skeleton 13429 tracks the system 13010 from akinematic and dynamics point of view. For example, the kinematics itemmay be implemented either as forward or inverse kinematics, in anexemplification. The dynamics item may be implemented as algorithms usedto model dynamics of the system's components.

The surgeon master module 13430 communicates with surgeon controldevices at the console 13005 and relays inputs received from the console13005 to the core module 13420. In accordance with an exemplification,the surgeon master module 13430 communicates button status and controldevice positions to the core module 13420 and includes a node controller13432 that includes a state/mode manager 13434, a fail-over controller13436, and a N-degree of freedom (“DOF”) actuator 13438.

The robotic arm module 13440 coordinates operation of a robotic armsubsystem, an arm cart subsystem, a set up arm, and an instrumentsubsystem in order to control movement of a corresponding arm 13002,13003. Although a single robotic arm module 13440 is included, it willbe appreciated that the robotic arm module 13440 corresponds to andcontrols a single arm. As such, additional robotic arm modules 13440 areincluded in configurations in which the system 13010 includes multiplearms 13002, 13003. The robotic arm module 13440 includes a nodecontroller 13442, a state/mode manager 13444, a fail-over controller13446, and a N-degree of freedom (“DOF”) actuator 13348.

The instrument module 13450 controls movement of an instrument and/ortool component attached to the arm 13002, 13003. The instrument module13450 is configured to correspond to and control a single instrument.Thus, in configurations in which multiple instruments are included,additional instrument modules 13450 are likewise included. In anexemplification, the instrument module 13450 obtains and communicatesdata related to the position of the end effector or jaw assembly (whichmay include the pitch and yaw angle of the jaws), the width of or theangle between the jaws, and the position of an access port. Theinstrument module 13450 has a node controller 13452, a state/modemanager 13454, a fail-over controller 13456, and a N-degree of freedom(“DOF”) actuator 13458.

The position data collected by the instrument module 13450 is used bythe core module 13420 to determine when the instrument is within thesurgical site, within a cannula, adjacent to an access port, or above anaccess port in free space. The core module 13420 can determine whetherto provide instructions to open or close the jaws of the instrumentbased on the positioning thereof. For example, when the position of theinstrument indicates that the instrument is within a cannula,instructions are provided to maintain a jaw assembly in a closedposition. When the position of the instrument indicates that theinstrument is outside of an access port, instructions are provided toopen the jaw assembly.

Additional features and operations of a robotic surgical system, such asthe surgical robot system depicted in FIGS. 4 and 5 , are furtherdescribed in the following references, each of which is hereinincorporated by reference in its entirety:

-   U.S. Patent Application Publication No. 2016/0303743, filed Jun. 6,    2016, titled WRIST AND JAW ASSEMBLIES FOR ROBOTIC SURGICAL SYSTEMS;-   U.S. Patent Application Publication No. 2017/0071693, filed Nov. 11,    2016, titled SURGICAL ROBOTIC ARM SUPPORT SYSTEMS AND METHODS OF    USE;-   International Patent Publication No. WO2016/144937, filed Mar. 8,    2016, titled MEASURING HEALTH OF A CONNECTOR MEMBER OF A ROBOTIC    SURGICAL SYSTEM;-   International Patent Publication No. WO2016/144998, filed Mar. 9,    2016, titled ROBOTIC SURGICAL SYSTEMS, INSTRUMENT DRIVE UNITS, AND    DRIVE ASSEMBLIES;-   International Patent Publication No. WO2016/183054, filed May 10,    2016, titled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC SURGICAL    INSTRUMENT;-   International Patent Publication No. WO2016/205266, filed Jun. 15,    2016, titled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION SENSING;-   International Patent Publication No. WO2016/205452, filed Jun. 16,    2016, titled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITH    BIDIRECTIONAL COUPLING;-   International Patent Publication No. WO2016/209769, filed Jun. 20,    2016, titled ROBOTIC SURGICAL ASSEMBLIES;-   International Patent Publication No. WO2017/044406, filed Sep. 6,    2016, titled ROBOTIC SURGICAL CONTROL SCHEME FOR MANIPULATING    ROBOTIC END EFFECTORS;-   International Patent Publication No. WO2017/053358, filed Sep. 21,    2016, titled SURGICAL ROBOTIC ASSEMBLIES AND INSTRUMENT ADAPTERS    THEREOF;-   International Patent Publication No. WO2017/053363, filed Sep. 21,    2016, titled ROBOTIC SURGICAL ASSEMBLIES AND INSTRUMENT DRIVE    CONNECTORS THEREOF;-   International Patent Publication No. WO2017/053507, filed Sep. 22,    2016, titled ELASTIC SURGICAL INTERFACE FOR ROBOTIC SURGICAL    SYSTEMS;-   International Patent Publication No. WO2017/053698, filed Sep. 23,    2016, titled ROBOTIC SURGICAL ASSEMBLIES AND ELECTROMECHANICAL    INSTRUMENTS THEREOF;-   International Patent Publication No. WO2017/075121, filed Oct. 27,    2016, titled HAPTIC FEEDBACK CONTROLS FOR A ROBOTIC SURGICAL SYSTEM    INTERFACE; and-   International Patent Publication No. WO2017/116793, filed Dec. 19,    2016, titled ROBOTIC SURGICAL SYSTEMS AND INSTRUMENT DRIVE    ASSEMBLIES.

The robotic surgical systems and features disclosed herein can beemployed with the robotic surgical system of FIGS. 4 and 5 . The readerwill further appreciate that various systems and/or features disclosedherein can also be employed with alternative surgical systems includingthe computer-implemented interactive surgical system 100, thecomputer-implemented interactive surgical system 200, the roboticsurgical system 110, the robotic hub 122, and/or the robotic hub 222,for example.

In various instances, a robotic surgical system can include a roboticcontrol tower, which can house the control unit of the system. Forexample, the control unit 13004 of the robotic surgical system 13000(FIG. 4 ) can be housed within a robotic control tower. The roboticcontrol tower can include a robotic hub such as the robotic hub 122(FIG. 2 ) or the robotic hub 222 (FIG. 9 ), for example. Such a robotichub can include a modular interface for coupling with one or moregenerators, such as an ultrasonic generator and/or a radio frequencygenerator, and/or one or more modules, such as an imaging module,suction module, an irrigation module, a smoke evacuation module, and/ora communication module.

A robotic hub can include a situational awareness module, which can beconfigured to synthesize data from multiple sources to determine anappropriate response to a surgical event. For example, a situationalawareness module can determine the type of surgical procedure, step inthe surgical procedure, type of tissue, and/or tissue characteristics,as further described herein. Moreover, such a module can recommend aparticular course of action or possible choices to the robotic systembased on the synthesized data. In various instances, a sensor systemencompassing a plurality of sensors distributed throughout the roboticsystem can provide data, images, and/or other information to thesituational awareness module. Such a situational awareness module can beincorporated into a control unit, such as the control unit 13004, forexample. In various instances, the situational awareness module canobtain data and/or information from a non-robotic surgical hub and/or acloud, such as the surgical hub 106 (FIG. 1 ), the surgical hub 206(FIG. 10 ), the cloud 104 (FIG. 1 ), and/or the cloud 204 (FIG. 9 ), forexample. Situational awareness of a surgical system is further disclosedherein and in U.S. Provisional Patent Application Ser. No. 62/611,341,titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, and U.S.Provisional Patent Application Ser. No. 62/611,340, titled CLOUD-BASEDMEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of each of whichis herein incorporated by reference in its entirety.

In certain instances, the activation of a surgical tool at certain timesduring a surgical procedure and/or for certain durations may causetissue trauma and/or may prolong a surgical procedure. For example, arobotic surgical system can utilize an electrosurgical tool having anenergy delivery surface that should only be energized when a thresholdcondition is met. In one example, the energy delivery surface shouldonly be activated when the energy delivery surface is in contact withthe appropriate, or targeted, tissue. As another example, a roboticsurgical system can utilize a suction element that should only beactivated when a threshold condition is met, such as when an appropriatevolume of fluid is present. Due to visibility restrictions, evolvingsituations, and the multitude of moving parts during a robotic surgicalprocedure, it can be difficult for a clinician to determine and/ormonitor certain conditions at the surgical site. For example, it can bedifficult to determine if an energy delivery surface of anelectrosurgical tool is in contact with tissue. It can also be difficultto determine if a particular suctioning pressure is sufficient for thevolume of fluid in the proximity of the suctioning port.

Moreover, a plurality of surgical devices can be used in certain roboticsurgical procedures. For example, a robotic surgical system can use oneor more surgical tools during the surgical procedure. Additionally, oneor more handheld instruments can also be used during the surgicalprocedure. One or more of the surgical devices can include a sensor. Forexample, multiple sensors can be positioned around the surgical siteand/or the operating room. A sensor system including the one or moresensors can be configured to detect one or more conditions at thesurgical site. For example, data from the sensor system can determine ifa surgical tool mounted to the surgical robot is being used and/or if afeature of the surgical tool should be activated. More specifically, asensor system can detect if an electrosurgical device is positioned inabutting contact with tissue, for example. As another example, a sensorsystem can detect if a suctioning element of a surgical tool is applyinga sufficient suctioning force to fluid at the surgical site.

When in an automatic activation mode, the robotic surgical system canautomatically activate one or more features of one or more surgicaltools based on data, images, and/or other information received from thesensor system. For example, an energy delivery surface of anelectrosurgical tool can be activated upon detecting that theelectrosurgical tool is in use (e.g. positioned in abutting contact withtissue). As another example, a suctioning element on a surgical tool canbe activated when the suction port is moved into contact with a fluid.In certain instances, the surgical tool can be adjusted based on thesensed conditions.

A robotic surgical system incorporating an automatic activation mode canautomatically provide a scenario-specific result based on detectedcondition(s) at the surgical site. The scenario-specific result can beoutcome-based, for example, and can streamline the decision-makingprocess of the clinician. In certain instances, such an automaticactivation mode can improve the efficiency and/or effectiveness of theclinician. For example, the robotic surgical system can aggregate datato compile a more complete view of the surgical site and/or the surgicalprocedure in order to determine the best possible course of action.Additionally or alternatively, in instances in which the clinician makesfewer decisions, the clinician can be better focused on other tasksand/or can process other information more effectively.

Referring primarily to FIGS. 6 and 7 , hubs 13380, 13382 includewireless communication modules such that a wireless communication linkis established between the two hubs 13380, 13382. Additionally, therobotic hub 13380 is in signal communication with the interactivesecondary displays 13362, 13364 within the sterile field. The hub 13382is in signal communication with the handheld surgical instrument 13366.If the surgeon 13371 moves over towards the patient 13361 and within thesterile field (as indicated by the reference character 13371′), thesurgeon 13371 can use one of the wireless interactive displays 13362,13364 to operate the robot 13372 away from the remote command console13370. The plurality of secondary displays 13362, 13364 within thesterile field allows the surgeon 13371 to move away from the remotecommand console 13370 without losing sight of important information forthe surgical procedure and controls for the robotic tools utilizedtherein.

The interactive secondary displays 13362, 13364 permit the clinician tostep away from the remote command console 13370 and into the sterilefield while maintaining control of the robot 13372. For example, theinteractive secondary displays 13362, 13364 allow the clinician tomaintain cooperative and/or coordinated control over the poweredhandheld surgical instrument(s) 13366 and the robotic surgical system atthe same time. In various instances, information is communicated betweenthe robotic surgical system, one or more powered handheld surgicalinstruments 13366, surgical hubs 13380, 13382, and the interactivesecondary displays 13362, 13364. Such information may include, forexample, the images on the display of the robotic surgical system and/orthe powered handheld surgical instruments, a parameter of the roboticsurgical system and/or the powered handheld surgical instruments, and/ora control command for the robotic surgical system and/or the poweredhandheld surgical instruments.

In various instances, the control unit of the robotic surgical system(e.g. the control unit 13113 of the robotic surgical system 13110) isconfigured to communicate at least one display element from thesurgeon's command console (e.g. the console 13116) to an interactivesecondary display (e.g. the displays 13362, 13364). In other words, aportion of the display at the surgeon's console is replicated on thedisplay of the interactive secondary display, integrating the robotdisplay with the interactive secondary display. The replication of therobot display on to the display of the interactive secondary displayallows the clinician to step away from the remote command consolewithout losing the visual image that is displayed there. For example, atleast one of the interactive secondary displays 13362, 13364 can displayinformation from the robot, such as information from the robot displayand/or the surgeon's command console 13370.

In various instances, the interactive secondary displays 13362, 13364are configured to control and/or adjust at least one operating parameterof the robotic surgical system. Such control can occur automaticallyand/or in response to a clinician input. Interacting with atouch-sensitive screen and/or buttons on the interactive secondarydisplay(s) 13362, 13364, the clinician is able to input a command tocontrol movement and/or functionality of the one or more robotic tools.For example, when utilizing a handheld surgical instrument 13366, theclinician may want to move the robotic tool 13374 to a differentposition. To control the robotic tool 13374, the clinician applies aninput to the interactive secondary display(s) 13362, 13364, and therespective interactive secondary display(s) 13362, 13364 communicatesthe clinician input to the control unit of the robotic surgical systemin the robotic hub 13380.

In various instances, a clinician positioned at the remote commandconsole 13370 of the robotic surgical system can manually override anyrobot command initiated by a clinician input on the one or moreinteractive secondary displays 13362, 13364. For example, when aclinician input is received from the one or more interactive secondarydisplays 13362, 13364, a clinician positioned at the remote commandconsole 13370 can either allow the command to be issued and the desiredfunction performed or the clinician can override the command byinteracting with the remote command console 13370 and prohibiting thecommand from being issued.

In certain instances, a clinician within the sterile field can berequired to request permission to control the robot 13372 and/or therobotic tool 13374 mounted thereto. The surgeon 13371 at the remotecommand console 13370 can grant or deny the clinician's request. Forexample, the surgeon can receive a pop-up or other notificationindicating the permission is being requested by another clinicianoperating a handheld surgical instrument and/or interacting with aninteractive secondary display 13362, 13364.

In various instances, the processor of a robotic surgical system, suchas the robotic surgical systems 13000 (FIG. 4 ), 13400 (FIG. 5 ), 13360(FIG. 6 ), and/or the surgical hub 13380, 13382, for example, isprogrammed with pre-approved functions of the robotic surgical system.For example, if a clinician input from the interactive secondary display13362, 13364 corresponds to a pre-approved function, the roboticsurgical system allows for the interactive secondary display 13362,13364 to control the robotic surgical system and/or does not prohibitthe interactive secondary display 13362, 13364 from controlling therobotic surgical system. If a clinician input from the interactivesecondary display 13362, 13364 does not correspond to a pre-approvedfunction, the interactive secondary display 13362, 13364 is unable tocommand the robotic surgical system to perform the desired function. Inone instances, a situational awareness module in the robotic hub 13370and/or the surgical hub 13382 is configured to dictate and/or influencewhen the interactive secondary display can issue control motions to therobot surgical system.

In various instances, an interactive secondary display 13362, 13364 hascontrol over a portion of the robotic surgical system upon makingcontact with the portion of the robotic surgical system. For example,when the interactive secondary display 13362, 13364 is brought intocontact with the robotic tool 13374, control of the contacted robotictool 13374 is granted to the interactive secondary display 13362, 13364.A clinician can then utilize a touch-sensitive screen and/or buttons onthe interactive secondary display 13362, 13364 to input a command tocontrol movement and/or functionality of the contacted robotic tool13374. This control scheme allows for a clinician to reposition arobotic arm, reload a robotic tool, and/or otherwise reconfigure therobotic surgical system. In a similar manner as discussed above, theclinician 13371 positioned at the remote command console 13370 of therobotic surgical system can manually override any robot commandinitiated by the interactive secondary display 13362, 13364.

In one aspect, the robotic surgical system includes a processor and amemory communicatively coupled to the processor, as described herein.The memory stores instructions executable by the processor to receive afirst user input from a console and to receive a second user input froma mobile wireless control module for controlling a function of a roboticsurgical tool, as described herein.

In various aspects, the present disclosure provides a control circuit toreceive a first user input from a console and to receive a second userinput from a mobile wireless control module for controlling a functionof a robotic surgical tool, as described herein. In various aspects, thepresent disclosure provides a non-transitory computer readable mediumstoring computer readable instructions which, when executed, cause amachine to receive a first user input from a console and to receive asecond user input from a mobile wireless control module for controllinga function of a robotic surgical tool, as described herein.

A robotic surgical system may include multiple robotic arms that areconfigured to assist the clinician during a surgical procedure. Eachrobotic arm may be operable independently of the others. A lack ofcommunication may exist between each of the robotic arms as they areindependently operated, which may increase the risk of tissue trauma.For example, in a scenario where one robotic arm is configured to applya force that is stronger and in a different direction than a forceconfigured to be applied by a second robotic arm, tissue trauma canresult. For example, tissue trauma and/or tearing may occur when a firstrobotic arm applies a strong retracting force to the tissue while asecond robotic arm is configured to rigidly hold the tissue in place.

In various instances, one or more sensors are attached to each roboticarm of a robotic surgical system. The one or more sensors are configuredto sense a force applied to the surrounding tissue during the operationof the robotic arm. Such forces can include, for example, a holdingforce, a retracting force, and/or a dragging force. The sensor from eachrobotic arm is configured to communicate the magnitude and direction ofthe detected force to a control unit of the robotic surgical system. Thecontrol unit is configured to analyze the communicated forces and setlimits for maximum loads to avoid causing trauma to the tissue in asurgical site. For example, the control unit may minimize the holdingforce applied by a first robotic arm if the retracting or dragging forceapplied by a second robotic arm increases.

FIG. 4A illustrates an exemplification of a robotic arm 13120 and a toolassembly 13130 releasably coupled to the robotic arm 13120. The roboticarm 13120 can support and move the associated tool assembly 13130 alongone or more mechanical degrees of freedom (e.g., all six Cartesiandegrees of freedom, five or fewer Cartesian degrees of freedom, etc.).

The robotic arm 13120 can include a tool driver 13140 at a distal end ofthe robotic arm 13120, which can assist with controlling featuresassociated with the tool assembly 13130. The robotic arm 13120 can alsoinclude a movable tool guide 13132 that can retract and extend relativeto the tool driver 13140. A shaft of the tool assembly 13130 can extendparallel to a threaded shaft of the movable tool guide 13132 and canextend through a distal end feature 13133 (e.g., a ring) of the movabletool guide 13132 and into a patient.

In order to provide a sterile operation area while using the surgicalsystem, a barrier can be placed between the actuating portion of thesurgical system (e.g., the robotic arm 13120) and the surgicalinstruments (e.g., the tool assembly 13130) in the sterile surgicalfield. A sterile component, such as an instrument sterile adapter (ISA),can also be placed at the connecting interface between the tool assembly13130 and the robotic arm 13120. The placement of an ISA between thetool assembly 13130 and the robotic arm 13120 can ensure a sterilecoupling point for the tool assembly 13130 and the robotic arm 13120.This permits removal of tool assemblies 13130 from the robotic arm 13120to exchange with other tool assemblies 13130 during the course of asurgery without compromising the sterile surgical field.

The tool assembly 13130 can be loaded from a top side of the tool driver13140 with the shaft of the tool assembly 13130 being positioned in ashaft-receiving channel 13144 formed along the side of the tool driver13140. The shaft-receiving channel 13144 allows the shaft, which extendsalong a central axis of the tool assembly 13130, to extend along acentral axis of the tool driver 13140 when the tool assembly 13130 iscoupled to the tool driver 13140. In other exemplifications, the shaftcan extend through on opening in the tool driver 13140, or the twocomponents can mate in various other configurations.

As discussed above, the robotic surgical system can include one or morerobotic arms with each robotic arm having a tool assembly coupledthereto. Each tool assembly can include an end effector that has one ormore of a variety of features, such as one or more tools for assistingwith performing a surgical procedure. For example, the end effector caninclude a cutting or boring tool that can be used to perforate or cutthrough tissue (e.g., create an incision).

Furthermore, some end effectors include one or more sensors that cansense a variety of characteristics associated with either the endeffector or the tissue. Each robotic arm and end effector can becontrolled by a control system to assist with creating a desired cut orbore and prevent against undesired cutting of tissue. As an alternativeto (or in addition to) controlling the robotic arm, it is understoodthat the control system can control either the tool itself or the toolassembly.

One or more aspects associated with the movement of the robotic arm canbe controlled by the control system, such as either a direction or avelocity of movement. For example, when boring through tissue, therobotic arm can be controlled to perform jackhammer-like movements withthe cutting tool. Such jackhammer movements can include the robotic armmoving up and down along an axis (e.g., an axis that is approximatelyperpendicular to the tissue being perforated) in a rapid motion whilealso advancing the cutting tool in a downward direction towards thetissue to eventually perforate the tissue with the cutting tool (e.g. anultrasonic blade). While performing such movements in a robotic surgicalprocedure, not only can it be difficult to see the tissue beingperforated to thereby determine a relative position of the cutting tool,but it can also be difficult to determine when the cutting tool hascompleted perforating the tissue. Such position of the cutting toolrelative to the tissue can include the cutting tool approaching or notyet in contact with the tissue, the cutting tool drilling down orcutting into the tissue, and the cutting tool extending through orhaving perforated the tissue. These positions can be difficult foreither a user controlling the robotic arm or the robotic surgical systemto determine which can result in potential harm to the patient due toover or under-penetrating the tissue, as well as result in longerprocedure times. As such, in order to reduce procedure time and surgicalerrors, the robotic surgical system includes a control system thatcommunicates with at least one sensor assembly configured to sense aforce applied at a distal end of the end effector or cutting tool. Thecontrol system can thereby determine and control, based on such sensedforces, one or more appropriate aspects associated with the movement ofthe robotic arm, such as when boring or cutting into tissue, as will bedescribed in greater detail below.

Although a cutting tool for perforating tissue is described in detailherein, the sensor assembly of the present disclosure that is incommunication with the control system can be implemented in any numberof robotic surgical systems for detecting any number of a variety oftools and/or end effectors used for performing any number of a varietyof procedures without departing from the scope of this disclosure.Furthermore, any number of movements can be performed by the robotic armto perforate or cut tissue using the robotic surgical system includingthe sensor assembly and control system described herein and is notlimited to the jackhammering or boring of tissue.

FIG. 4A and additional exemplifications are further described in U.S.patent application Ser. No. 15/237,753, entitled CONTROL OF ADVANCEMENTRATE AND APPLICATION FORCE BASED ON MEASURED FORCES, filed Aug. 16,2016, the entire disclosure of which is incorporated by referenceherein.

The entire disclosures of:

-   U.S. Pat. No. 9,072,535, filed May 27, 2011, entitled SURGICAL    STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS,    which issued Jul. 7, 2015;-   U.S. Pat. No. 9,072,536, filed Jun. 28, 2012, entitled DIFFERENTIAL    LOCKING ARRANGEMENTS FOR ROTARY POWERED SURGICAL INSTRUMENTS, which    issued Jul. 7, 2015;-   U.S. Pat. No. 9,204,879, filed Jun. 28, 2012, entitled FLEXIBLE    DRIVE MEMBER, which issued on Dec. 8, 2015;-   U.S. Pat. No. 9,561,038, filed Jun. 28, 2012, entitled    INTERCHANGEABLE CLIP APPLIER, which issued on Feb. 7, 2017;-   U.S. Pat. No. 9,757,128, filed Sep. 5, 2014, entitled MULTIPLE    SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR    INTERPRETATION, which issued on Sep. 12, 2017;-   U.S. patent application Ser. No. 14/640,935, entitled OVERLAID MULTI    SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE    COMPRESSION, filed Mar. 6, 2015, now U.S. Patent Application    Publication No. 2016/0256071;-   U.S. patent application Ser. No. 15/382,238, entitled MODULAR    BATTERY POWERED HANDHELD SURGICAL INSTRUMENT WITH SELECTIVE    APPLICATION OF ENERGY BASED ON TISSUE CHARACTERIZATION, filed Dec.    16, 2016, now U.S. Patent Application Publication No. 2017/0202591;    and-   U.S. patent application Ser. No. 15/237,753, entitled CONTROL OF    ADVANCEMENT RATE AND APPLICATION FORCE BASED ON MEASURED FORCES,    filed Aug. 16, 2016 are hereby incorporated by reference herein in    their respective entireties.

The surgical devices, systems, and methods disclosed herein can beimplemented with a variety of different robotic surgical systems andsurgical devices. Surgical devices include robotic surgical tools andhandheld surgical instruments. The reader will readily appreciate thatcertain devices, systems, and methods disclosed herein are not limitedto applications within a robotic surgical system. For example, certainsystems, devices, and methods for communicating, detecting, and/orcontrol a surgical device can be implemented without a robotic surgicalsystem.

Surgical Network

FIG. 8 illustrates a surgical data network 201 comprising a modularcommunication hub 203 configured to connect modular devices located inone or more operating theaters of a healthcare facility, or any room ina healthcare facility specially equipped for surgical operations, to acloud-based system (e.g., the cloud 204 that may include a remote server213 coupled to a storage device 205). In one aspect, the modularcommunication hub 203 comprises a network hub 207 and/or a networkswitch 209 in communication with a network router. The modularcommunication hub 203 also can be coupled to a local computer system 210to provide local computer processing and data manipulation. The surgicaldata network 201 may be configured as passive, intelligent, orswitching. A passive surgical data network serves as a conduit for thedata, enabling it to go from one device (or segment) to another and tothe cloud computing resources. An intelligent surgical data networkincludes additional features to enable the traffic passing through thesurgical data network to be monitored and to configure each port in thenetwork hub 207 or network switch 209. An intelligent surgical datanetwork may be referred to as a manageable hub or switch. A switchinghub reads the destination address of each packet and then forwards thepacket to the correct port.

Modular devices 1 a-1 n located in the operating theater may be coupledto the modular communication hub 203. The network hub 207 and/or thenetwork switch 209 may be coupled to a network router 211 to connect thedevices 1 a-1 n to the cloud 204 or the local computer system 210. Dataassociated with the devices 1 a-1 n may be transferred to cloud-basedcomputers via the router for remote data processing and manipulation.Data associated with the devices 1 a-1 n may also be transferred to thelocal computer system 210 for local data processing and manipulation.Modular devices 2 a-2 m located in the same operating theater also maybe coupled to a network switch 209. The network switch 209 may becoupled to the network hub 207 and/or the network router 211 to connectto the devices 2 a-2 m to the cloud 204. Data associated with thedevices 2 a-2 n may be transferred to the cloud 204 via the networkrouter 211 for data processing and manipulation. Data associated withthe devices 2 a-2 m may also be transferred to the local computer system210 for local data processing and manipulation.

It will be appreciated that the surgical data network 201 may beexpanded by interconnecting multiple network hubs 207 and/or multiplenetwork switches 209 with multiple network routers 211. The modularcommunication hub 203 may be contained in a modular control towerconfigured to receive multiple devices 1 a-1 n/2 a-2 m. The localcomputer system 210 also may be contained in a modular control tower.The modular communication hub 203 is connected to a display 212 todisplay images obtained by some of the devices 1 a-1 n/2 a-2 m, forexample during surgical procedures. In various aspects, the devices 1a-1 n/2 a-2 m may include, for example, various modules such as animaging module 138 coupled to an endoscope, a generator module 140coupled to an energy-based surgical device, a smoke evacuation module126, a suction/irrigation module 128, a communication module 130, aprocessor module 132, a storage array 134, a surgical device coupled toa display, and/or a non-contact sensor module, among other modulardevices that may be connected to the modular communication hub 203 ofthe surgical data network 201.

In one aspect, the surgical data network 201 may comprise a combinationof network hub(s), network switch(es), and network router(s) connectingthe devices 1 a-1 n/2 a-2 m to the cloud. Any one of or all of thedevices 1 a-1 n/2 a-2 m coupled to the network hub or network switch maycollect data in real time and transfer the data to cloud computers fordata processing and manipulation. It will be appreciated that cloudcomputing relies on sharing computing resources rather than having localservers or personal devices to handle software applications. The word“cloud” may be used as a metaphor for “the Internet,” although the termis not limited as such. Accordingly, the term “cloud computing” may beused herein to refer to “a type of Internet-based computing,” wheredifferent services—such as servers, storage, and applications—aredelivered to the modular communication hub 203 and/or computer system210 located in the surgical theater (e.g., a fixed, mobile, temporary,or field operating room or space) and to devices connected to themodular communication hub 203 and/or computer system 210 through theInternet. The cloud infrastructure may be maintained by a cloud serviceprovider. In this context, the cloud service provider may be the entitythat coordinates the usage and control of the devices 1 a-1 n/2 a-2 mlocated in one or more operating theaters. The cloud computing servicescan perform a large number of calculations based on the data gathered bysmart surgical instruments, robots, and other computerized deviceslocated in the operating theater. The hub hardware enables multipledevices or connections to be connected to a computer that communicateswith the cloud computing resources and storage.

Applying cloud computer data processing techniques on the data collectedby the devices 1 a-1 n/2 a-2 m, the surgical data network providesimproved surgical outcomes, reduced costs, and improved patientsatisfaction. At least some of the devices 1 a-1 n/2 a-2 m may beemployed to view tissue states to assess leaks or perfusion of sealedtissue after a tissue sealing and cutting procedure. At least some ofthe devices 1 a-1 n/2 a-2 m may be employed to identify pathology, suchas the effects of diseases, using the cloud-based computing to examinedata including images of samples of body tissue for diagnostic purposes.This includes localization and margin confirmation of tissue andphenotypes. At least some of the devices 1 a-1 n/2 a-2 m may be employedto identify anatomical structures of the body using a variety of sensorsintegrated with imaging devices and techniques such as overlaying imagescaptured by multiple imaging devices. The data gathered by the devices 1a-1 n/2 a-2 m, including image data, may be transferred to the cloud 204or the local computer system 210 or both for data processing andmanipulation including image processing and manipulation. The data maybe analyzed to improve surgical procedure outcomes by determining iffurther treatment, such as the application of endoscopic intervention,emerging technologies, a targeted radiation, targeted intervention, andprecise robotics to tissue-specific sites and conditions, may bepursued. Such data analysis may further employ outcome analyticsprocessing, and using standardized approaches may provide beneficialfeedback to either confirm surgical treatments and the behavior of thesurgeon or suggest modifications to surgical treatments and the behaviorof the surgeon.

In one implementation, the operating theater devices 1 a-1 n may beconnected to the modular communication hub 203 over a wired channel or awireless channel depending on the configuration of the devices 1 a-1 nto a network hub. The network hub 207 may be implemented, in one aspect,as a local network broadcast device that works on the physical layer ofthe Open System Interconnection (OSI) model. The network hub providesconnectivity to the devices 1 a-1 n located in the same operatingtheater network. The network hub 207 collects data in the form ofpackets and sends them to the router in half duplex mode. The networkhub 207 does not store any media access control/internet protocol(MAC/IP) to transfer the device data. Only one of the devices 1 a-1 ncan send data at a time through the network hub 207. The network hub 207has no routing tables or intelligence regarding where to sendinformation and broadcasts all network data across each connection andto a remote server 213 (FIG. 9 ) over the cloud 204. The network hub 207can detect basic network errors such as collisions, but having allinformation broadcast to multiple ports can be a security risk and causebottlenecks.

In another implementation, the operating theater devices 2 a-2 m may beconnected to a network switch 209 over a wired channel or a wirelesschannel. The network switch 209 works in the data link layer of the OSImodel. The network switch 209 is a multicast device for connecting thedevices 2 a-2 m located in the same operating theater to the network.The network switch 209 sends data in the form of frames to the networkrouter 211 and works in full duplex mode. Multiple devices 2 a-2 m cansend data at the same time through the network switch 209. The networkswitch 209 stores and uses MAC addresses of the devices 2 a-2 m totransfer data.

The network hub 207 and/or the network switch 209 are coupled to thenetwork router 211 for connection to the cloud 204. The network router211 works in the network layer of the OSI model. The network router 211creates a route for transmitting data packets received from the networkhub 207 and/or network switch 211 to cloud-based computer resources forfurther processing and manipulation of the data collected by any one ofor all the devices 1 a-1 n/2 a-2 m. The network router 211 may beemployed to connect two or more different networks located in differentlocations, such as, for example, different operating theaters of thesame healthcare facility or different networks located in differentoperating theaters of different healthcare facilities. The networkrouter 211 sends data in the form of packets to the cloud 204 and worksin full duplex mode. Multiple devices can send data at the same time.The network router 211 uses IP addresses to transfer data.

In one example, the network hub 207 may be implemented as a USB hub,which allows multiple USB devices to be connected to a host computer.The USB hub may expand a single USB port into several tiers so thatthere are more ports available to connect devices to the host systemcomputer. The network hub 207 may include wired or wireless capabilitiesto receive information over a wired channel or a wireless channel. Inone aspect, a wireless USB short-range, high-bandwidth wireless radiocommunication protocol may be employed for communication between thedevices 1 a-1 n and devices 2 a-2 m located in the operating theater.

In other examples, the operating theater devices 1 a-1 n/2 a-2 m maycommunicate to the modular communication hub 203 via Bluetooth wirelesstechnology standard for exchanging data over short distances (usingshort-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz)from fixed and mobile devices and building personal area networks(PANs). In other aspects, the operating theater devices 1 a-1 n/2 a-2 mmay communicate to the modular communication hub 203 via a number ofwireless or wired communication standards or protocols, including butnot limited to Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family),IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+,HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivativesthereof, as well as any other wireless and wired protocols that aredesignated as 3G, 4G, 5G, and beyond. The computing module may include aplurality of communication modules. For instance, a first communicationmodule may be dedicated to shorter-range wireless communications such asWi-Fi and Bluetooth, and a second communication module may be dedicatedto longer-range wireless communications such as GPS, EDGE, GPRS, CDMA,WiMAX, LTE, Ev-DO, and others.

The modular communication hub 203 may serve as a central connection forone or all of the operating theater devices 1 a-1 n/2 a-2 m and handlesa data type known as frames. Frames carry the data generated by thedevices 1 a-1 n/2 a-2 m. When a frame is received by the modularcommunication hub 203, it is amplified and transmitted to the networkrouter 211, which transfers the data to the cloud computing resources byusing a number of wireless or wired communication standards orprotocols, as described herein.

The modular communication hub 203 can be used as a standalone device orbe connected to compatible network hubs and network switches to form alarger network. The modular communication hub 203 is generally easy toinstall, configure, and maintain, making it a good option for networkingthe operating theater devices 1 a-1 n/2 a-2 m.

FIG. 9 illustrates a computer-implemented interactive surgical system200. The computer-implemented interactive surgical system 200 is similarin many respects to the computer-implemented interactive surgical system100. For example, the computer-implemented interactive surgical system200 includes one or more surgical systems 202, which are similar in manyrespects to the surgical systems 102. Each surgical system 202 includesat least one surgical hub 206 in communication with a cloud 204 that mayinclude a remote server 213. In one aspect, the computer-implementedinteractive surgical system 200 comprises a modular control tower 236connected to multiple operating theater devices such as, for example,intelligent surgical instruments, robots, and other computerized deviceslocated in the operating theater. As shown in FIG. 10 , the modularcontrol tower 236 comprises a modular communication hub 203 coupled to acomputer system 210. As illustrated in the example of FIG. 9 , themodular control tower 236 is coupled to an imaging module 238 that iscoupled to an endoscope 239, a generator module 240 that is coupled toan energy device 241, a smoke evacuator module 226, a suction/irrigationmodule 228, a communication module 230, a processor module 232, astorage array 234, a smart device/instrument 235 optionally coupled to adisplay 237, and a non-contact sensor module 242. The operating theaterdevices are coupled to cloud computing resources and data storage viathe modular control tower 236. A robot hub 222 also may be connected tothe modular control tower 236 and to the cloud computing resources. Thedevices/instruments 235, visualization systems 208, among others, may becoupled to the modular control tower 236 via wired or wirelesscommunication standards or protocols, as described herein. The modularcontrol tower 236 may be coupled to a hub display 215 (e.g., monitor,screen) to display and overlay images received from the imaging module,device/instrument display, and/or other visualization systems 208. Thehub display also may display data received from devices connected to themodular control tower in conjunction with images and overlaid images.

FIG. 10 illustrates a surgical hub 206 comprising a plurality of modulescoupled to the modular control tower 236. The modular control tower 236comprises a modular communication hub 203, e.g., a network connectivitydevice, and a computer system 210 to provide local processing,visualization, and imaging, for example. As shown in FIG. 10 , themodular communication hub 203 may be connected in a tiered configurationto expand the number of modules (e.g., devices) that may be connected tothe modular communication hub 203 and transfer data associated with themodules to the computer system 210, cloud computing resources, or both.As shown in FIG. 10 , each of the network hubs/switches in the modularcommunication hub 203 includes three downstream ports and one upstreamport. The upstream network hub/switch is connected to a processor toprovide a communication connection to the cloud computing resources anda local display 217. Communication to the cloud 204 may be made eitherthrough a wired or a wireless communication channel.

The surgical hub 206 employs a non-contact sensor module 242 to measurethe dimensions of the operating theater and generate a map of thesurgical theater using either ultrasonic or laser-type non-contactmeasurement devices. An ultrasound-based non-contact sensor module scansthe operating theater by transmitting a burst of ultrasound andreceiving the echo when it bounces off the perimeter walls of anoperating theater as described under the heading “Surgical Hub SpatialAwareness Within an Operating Room” in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, the disclosure of which is herein incorporated byreference in its entirety, in which the sensor module is configured todetermine the size of the operating theater and to adjustBluetooth-pairing distance limits. A laser-based non-contact sensormodule scans the operating theater by transmitting laser light pulses,receiving laser light pulses that bounce off the perimeter walls of theoperating theater, and comparing the phase of the transmitted pulse tothe received pulse to determine the size of the operating theater and toadjust Bluetooth pairing distance limits, for example.

The computer system 210 comprises a processor 244 and a networkinterface 245. The processor 244 is coupled to a communication module247, storage 248, memory 249, non-volatile memory 250, and input/outputinterface 251 via a system bus. The system bus can be any of severaltypes of bus structure(s) including the memory bus or memory controller,a peripheral bus or external bus, and/or a local bus using any varietyof available bus architectures including, but not limited to, 9-bit bus,Industrial Standard Architecture (ISA), Micro-Charmel Architecture(MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESALocal Bus (VLB), Peripheral Component Interconnect (PCI), USB, AdvancedGraphics Port (AGP), Personal Computer Memory Card InternationalAssociation bus (PCMCIA), Small Computer Systems Interface (SCSI), orany other proprietary bus.

The processor 244 may be any single-core or multicore processor such asthose known under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising anon-chip memory of 256 KB single-cycle flash memory, or othernon-volatile memory, up to 40 MHz, a prefetch buffer to improveperformance above 40 MHz, a 32 KB single-cycle serial random accessmemory (SRAM), an internal read-only memory (ROM) loaded withStellarisWare® software, a 2 KB electrically erasable programmableread-only memory (EEPROM), and/or one or more pulse width modulation(PWM) modules, one or more quadrature encoder inputs (QEI) analogs, oneor more 12-bit analog-to-digital converters (ADCs) with 12 analog inputchannels, details of which are available for the product datasheet.

In one aspect, the processor 244 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The system memory includes volatile memory and non-volatile memory. Thebasic input/output system (BIOS), containing the basic routines totransfer information between elements within the computer system, suchas during start-up, is stored in non-volatile memory. For example, thenon-volatile memory can include ROM, programmable ROM (PROM),electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatilememory includes random-access memory (RAM), which acts as external cachememory. Moreover, RAM is available in many forms such as SRAM, dynamicRAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and directRambus RAM (DRRAM).

The computer system 210 also includes removable/non-removable,volatile/non-volatile computer storage media, such as for example diskstorage. The disk storage includes, but is not limited to, devices likea magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zipdrive, LS-60 drive, flash memory card, or memory stick. In addition, thedisk storage can include storage media separately or in combination withother storage media including, but not limited to, an optical disc drivesuch as a compact disc ROM device (CD-ROM), compact disc recordabledrive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or adigital versatile disc ROM drive (DVD-ROM). To facilitate the connectionof the disk storage devices to the system bus, a removable ornon-removable interface may be employed.

It is to be appreciated that the computer system 210 includes softwarethat acts as an intermediary between users and the basic computerresources described in a suitable operating environment. Such softwareincludes an operating system. The operating system, which can be storedon the disk storage, acts to control and allocate resources of thecomputer system. System applications take advantage of the management ofresources by the operating system through program modules and programdata stored either in the system memory or on the disk storage. It is tobe appreciated that various components described herein can beimplemented with various operating systems or combinations of operatingsystems.

A user enters commands or information into the computer system 210through input device(s) coupled to the I/O interface 251. The inputdevices include, but are not limited to, a pointing device such as amouse, trackball, stylus, touch pad, keyboard, microphone, joystick,game pad, satellite dish, scanner, TV tuner card, digital camera,digital video camera, web camera, and the like. These and other inputdevices connect to the processor through the system bus via interfaceport(s). The interface port(s) include, for example, a serial port, aparallel port, a game port, and a USB. The output device(s) use some ofthe same types of ports as input device(s). Thus, for example, a USBport may be used to provide input to the computer system and to outputinformation from the computer system to an output device. An outputadapter is provided to illustrate that there are some output deviceslike monitors, displays, speakers, and printers, among other outputdevices that require special adapters. The output adapters include, byway of illustration and not limitation, video and sound cards thatprovide a means of connection between the output device and the systembus. It should be noted that other devices and/or systems of devices,such as remote computer(s), provide both input and output capabilities.

The computer system 210 can operate in a networked environment usinglogical connections to one or more remote computers, such as cloudcomputer(s), or local computers. The remote cloud computer(s) can be apersonal computer, server, router, network PC, workstation,microprocessor-based appliance, peer device, or other common networknode, and the like, and typically includes many or all of the elementsdescribed relative to the computer system. For purposes of brevity, onlya memory storage device is illustrated with the remote computer(s). Theremote computer(s) is logically connected to the computer system througha network interface and then physically connected via a communicationconnection. The network interface encompasses communication networkssuch as local area networks (LANs) and wide area networks (WANs). LANtechnologies include Fiber Distributed Data Interface (FDDI), CopperDistributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE802.5 and the like. WAN technologies include, but are not limited to,point-to-point links, circuit-switching networks like IntegratedServices Digital Networks (ISDN) and variations thereon,packet-switching networks, and Digital Subscriber Lines (DSL).

In various aspects, the computer system 210 of FIG. 10 , the imagingmodule 238 and/or visualization system 208, and/or the processor module232 of FIGS. 9-10 , may comprise an image processor, image processingengine, media processor, or any specialized digital signal processor(DSP) used for the processing of digital images. The image processor mayemploy parallel computing with single instruction, multiple data (SIMD)or multiple instruction, multiple data (MIMD) technologies to increasespeed and efficiency. The digital image processing engine can perform arange of tasks. The image processor may be a system on a chip withmulticore processor architecture.

The communication connection(s) refers to the hardware/software employedto connect the network interface to the bus. While the communicationconnection is shown for illustrative clarity inside the computer system,it can also be external to the computer system 210. Thehardware/software necessary for connection to the network interfaceincludes, for illustrative purposes only, internal and externaltechnologies such as modems, including regular telephone-grade modems,cable modems, and DSL modems, ISDN adapters, and Ethernet cards.

FIG. 11 illustrates a functional block diagram of one aspect of a USBnetwork hub 300 device, according to one aspect of the presentdisclosure. In the illustrated aspect, the USB network hub device 300employs a TUSB2036 integrated circuit hub by Texas Instruments. The USBnetwork hub 300 is a CMOS device that provides an upstream USBtransceiver port 302 and up to three downstream USB transceiver ports304, 306, 308 in compliance with the USB 2.0 specification. The upstreamUSB transceiver port 302 is a differential root data port comprising adifferential data minus (DM0) input paired with a differential data plus(DP0) input. The three downstream USB transceiver ports 304, 306, 308are differential data ports where each port includes differential dataplus (DP1-DP3) outputs paired with differential data minus (DM1-DM3)outputs.

The USB network hub 300 device is implemented with a digital statemachine instead of a microcontroller, and no firmware programming isrequired. Fully compliant USB transceivers are integrated into thecircuit for the upstream USB transceiver port 302 and all downstream USBtransceiver ports 304, 306, 308. The downstream USB transceiver ports304, 306, 308 support both full-speed and low-speed devices byautomatically setting the slew rate according to the speed of the deviceattached to the ports. The USB network hub 300 device may be configuredeither in bus-powered or self-powered mode and includes a hub powerlogic 312 to manage power.

The USB network hub 300 device includes a serial interface engine 310(SIE). The SIE 310 is the front end of the USB network hub 300 hardwareand handles most of the protocol described in chapter 8 of the USBspecification. The SIE 310 typically comprehends signaling up to thetransaction level. The functions that it handles could include: packetrecognition, transaction sequencing, SOP, EOP, RESET, and RESUME signaldetection/generation, clock/data separation, non-return-to-zero invert(NRZI) data encoding/decoding and bit-stuffing, CRC generation andchecking (token and data), packet ID (PID) generation andchecking/decoding, and/or serial-parallel/parallel-serial conversion.The 310 receives a clock input 314 and is coupled to a suspend/resumelogic and frame timer 316 circuit and a hub repeater circuit 318 tocontrol communication between the upstream USB transceiver port 302 andthe downstream USB transceiver ports 304, 306, 308 through port logiccircuits 320, 322, 324. The SIE 310 is coupled to a command decoder 326via interface logic to control commands from a serial EEPROM via aserial EEPROM interface 330.

In various aspects, the USB network hub 300 can connect 127 functionsconfigured in up to six logical layers (tiers) to a single computer.Further, the USB network hub 300 can connect to all peripherals using astandardized four-wire cable that provides both communication and powerdistribution. The power configurations are bus-powered and self-poweredmodes. The USB network hub 300 may be configured to support four modesof power management: a bus-powered hub, with either individual-portpower management or ganged-port power management, and the self-poweredhub, with either individual-port power management or ganged-port powermanagement. In one aspect, using a USB cable, the USB network hub 300,the upstream USB transceiver port 302 is plugged into a USB hostcontroller, and the downstream USB transceiver ports 304, 306, 308 areexposed for connecting USB compatible devices, and so forth.

Surgical Instrument Hardware

FIG. 12 illustrates a logic diagram of a control system 470 of asurgical instrument or tool in accordance with one or more aspects ofthe present disclosure. The system 470 comprises a control circuit. Thecontrol circuit includes a microcontroller 461 comprising a processor462 and a memory 468. One or more of sensors 472, 474, 476, for example,provide real-time feedback to the processor 462. A motor 482, driven bya motor driver 492, operably couples a longitudinally movabledisplacement member to drive the I-beam knife element. A tracking system480 is configured to determine the position of the longitudinallymovable displacement member. The position information is provided to theprocessor 462, which can be programmed or configured to determine theposition of the longitudinally movable drive member as well as theposition of a firing member, firing bar, and I-beam knife element.Additional motors may be provided at the tool driver interface tocontrol I-beam firing, closure tube travel, shaft rotation, andarticulation. A display 473 displays a variety of operating conditionsof the instruments and may include touch screen functionality for datainput. Information displayed on the display 473 may be overlaid withimages acquired via endoscopic imaging modules.

In one aspect, the microcontroller 461 may be any single-core ormulticore processor such as those known under the trade name ARM Cortexby Texas Instruments. In one aspect, the main microcontroller 461 may bean LM4F230H5QR ARM Cortex-M4F Processor Core, available from TexasInstruments, for example, comprising an on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, and internal ROM loaded with StellarisWare® software,a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, and/orone or more 12-bit ADCs with 12 analog input channels, details of whichare available for the product datasheet.

In one aspect, the microcontroller 461 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 461 may be programmed to perform various functionssuch as precise control over the speed and position of the knife andarticulation systems. In one aspect, the microcontroller 461 includes aprocessor 462 and a memory 468. The electric motor 482 may be a brusheddirect current (DC) motor with a gearbox and mechanical links to anarticulation or knife system. In one aspect, a motor driver 492 may bean A3941 available from Allegro Microsystems, Inc. Other motor driversmay be readily substituted for use in the tracking system 480 comprisingan absolute positioning system. A detailed description of an absolutepositioning system is described in U.S. Patent Application PublicationNo. 2017/0296213, titled SYSTEMS AND METHODS FOR CONTROLLING A SURGICALSTAPLING AND CUTTING INSTRUMENT, which published on Oct. 19, 2017, whichis herein incorporated by reference in its entirety.

The microcontroller 461 may be programmed to provide precise controlover the speed and position of displacement members and articulationsystems. The microcontroller 461 may be configured to compute a responsein the software of the microcontroller 461. The computed response iscompared to a measured response of the actual system to obtain an“observed” response, which is used for actual feedback decisions. Theobserved response is a favorable, tuned value that balances the smooth,continuous nature of the simulated response with the measured response,which can detect outside influences on the system.

In one aspect, the motor 482 may be controlled by the motor driver 492and can be employed by the firing system of the surgical instrument ortool. In various forms, the motor 482 may be a brushed DC driving motorhaving a maximum rotational speed of approximately 25,000 RPM. In otherarrangements, the motor 482 may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 492 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motor 482can be powered by a power assembly releasably mounted to the handleassembly or tool housing for supplying control power to the surgicalinstrument or tool. The power assembly may comprise a battery which mayinclude a number of battery cells connected in series that can be usedas the power source to power the surgical instrument or tool. In certaincircumstances, the battery cells of the power assembly may bereplaceable and/or rechargeable. In at least one example, the batterycells can be lithium-ion batteries which can be couplable to andseparable from the power assembly.

The motor driver 492 may be an A3941 available from AllegroMicrosystems, Inc. The A3941 492 is a full-bridge controller for usewith external N-channel power metal-oxide semiconductor field-effecttransistors (MOSFETs) specifically designed for inductive loads, such asbrush DC motors. The driver 492 comprises a unique charge pump regulatorthat provides full (>10 V) gate drive for battery voltages down to 7 Vand allows the A3941 to operate with a reduced gate drive, down to 5.5V. A bootstrap capacitor may be employed to provide the above batterysupply voltage required for N-channel MOSFETs. An internal charge pumpfor the high-side drive allows DC (100% duty cycle) operation. The fullbridge can be driven in fast or slow decay modes using diode orsynchronous rectification. In the slow decay mode, current recirculationcan be through the high-side or the lowside FETs. The power FETs areprotected from shoot-through by resistor-adjustable dead time.Integrated diagnostics provide indications of undervoltage,overtemperature, and power bridge faults and can be configured toprotect the power MOSFETs under most short circuit conditions. Othermotor drivers may be readily substituted for use in the tracking system480 comprising an absolute positioning system.

The tracking system 480 comprises a controlled motor drive circuitarrangement comprising a position sensor 472 according to one aspect ofthis disclosure. The position sensor 472 for an absolute positioningsystem provides a unique position signal corresponding to the locationof a displacement member. In one aspect, the displacement memberrepresents a longitudinally movable drive member comprising a rack ofdrive teeth for meshing engagement with a corresponding drive gear of agear reducer assembly. In other aspects, the displacement memberrepresents the firing member, which could be adapted and configured toinclude a rack of drive teeth. In yet another aspect, the displacementmember represents a firing bar or the I-beam, each of which can beadapted and configured to include a rack of drive teeth. Accordingly, asused herein, the term displacement member is used generically to referto any movable member of the surgical instrument or tool such as thedrive member, the firing member, the firing bar, the I-beam, or anyelement that can be displaced. In one aspect, the longitudinally movabledrive member is coupled to the firing member, the firing bar, and theI-beam. Accordingly, the absolute positioning system can, in effect,track the linear displacement of the I-beam by tracking the lineardisplacement of the longitudinally movable drive member. In variousother aspects, the displacement member may be coupled to any positionsensor 472 suitable for measuring linear displacement. Thus, thelongitudinally movable drive member, the firing member, the firing bar,or the I-beam, or combinations thereof, may be coupled to any suitablelinear displacement sensor. Linear displacement sensors may includecontact or non-contact displacement sensors. Linear displacement sensorsmay comprise linear variable differential transformers (LVDT),differential variable reluctance transducers (DVRT), a slidepotentiometer, a magnetic sensing system comprising a movable magnet anda series of linearly arranged Hall effect sensors, a magnetic sensingsystem comprising a fixed magnet and a series of movable, linearlyarranged Hall effect sensors, an optical sensing system comprising amovable light source and a series of linearly arranged photo diodes orphoto detectors, an optical sensing system comprising a fixed lightsource and a series of movable linearly, arranged photo diodes or photodetectors, or any combination thereof.

The electric motor 482 can include a rotatable shaft that operablyinterfaces with a gear assembly that is mounted in meshing engagementwith a set, or rack, of drive teeth on the displacement member. A sensorelement may be operably coupled to a gear assembly such that a singlerevolution of the position sensor 472 element corresponds to some linearlongitudinal translation of the displacement member. An arrangement ofgearing and sensors can be connected to the linear actuator, via a rackand pinion arrangement, or a rotary actuator, via a spur gear or otherconnection. A power source supplies power to the absolute positioningsystem and an output indicator may display the output of the absolutepositioning system. The displacement member represents thelongitudinally movable drive member comprising a rack of drive teethformed thereon for meshing engagement with a corresponding drive gear ofthe gear reducer assembly. The displacement member represents thelongitudinally movable firing member, firing bar, I-beam, orcombinations thereof.

A single revolution of the sensor element associated with the positionsensor 472 is equivalent to a longitudinal linear displacement d1 of theof the displacement member, where d1 is the longitudinal linear distancethat the displacement member moves from point “a” to point “b” after asingle revolution of the sensor element coupled to the displacementmember. The sensor arrangement may be connected via a gear reductionthat results in the position sensor 472 completing one or morerevolutions for the full stroke of the displacement member. The positionsensor 472 may complete multiple revolutions for the full stroke of thedisplacement member.

A series of switches, where n is an integer greater than one, may beemployed alone or in combination with a gear reduction to provide aunique position signal for more than one revolution of the positionsensor 472. The state of the switches are fed back to themicrocontroller 461 that applies logic to determine a unique positionsignal corresponding to the longitudinal linear displacement d1+d2+ . .. dn of the displacement member. The output of the position sensor 472is provided to the microcontroller 461. The position sensor 472 of thesensor arrangement may comprise a magnetic sensor, an analog rotarysensor like a potentiometer, or an array of analog Hall-effect elements,which output a unique combination of position signals or values.

The position sensor 472 may comprise any number of magnetic sensingelements, such as, for example, magnetic sensors classified according towhether they measure the total magnetic field or the vector componentsof the magnetic field. The techniques used to produce both types ofmagnetic sensors encompass many aspects of physics and electronics. Thetechnologies used for magnetic field sensing include search coil,fluxgate, optically pumped, nuclear precession, SQUID, Hall-effect,anisotropic magnetoresistance, giant magnetoresistance, magnetic tunneljunctions, giant magnetoimpedance, magnetostrictive/piezoelectriccomposites, magnetodiode, magnetotransistor, fiber-optic, magneto-optic,and microelectromechanical systems-based magnetic sensors, among others.

In one aspect, the position sensor 472 for the tracking system 480comprising an absolute positioning system comprises a magnetic rotaryabsolute positioning system. The position sensor 472 may be implementedas an AS5055EQFT single-chip magnetic rotary position sensor availablefrom Austria Microsystems, AG. The position sensor 472 is interfacedwith the microcontroller 461 to provide an absolute positioning system.The position sensor 472 is a low-voltage and low-power component andincludes four Hall-effect elements in an area of the position sensor 472that is located above a magnet. A high-resolution ADC and a smart powermanagement controller are also provided on the chip. A coordinaterotation digital computer (CORDIC) processor, also known as thedigit-by-digit method and Volder's algorithm, is provided to implement asimple and efficient algorithm to calculate hyperbolic and trigonometricfunctions that require only addition, subtraction, bitshift, and tablelookup operations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface, such as a serial peripheral interface (SPI) interface, to themicrocontroller 461. The position sensor 472 provides 12 or 14 bits ofresolution. The position sensor 472 may be an AS5055 chip provided in asmall QFN 16-pin 4×4×0.85 mm package.

The tracking system 480 comprising an absolute positioning system maycomprise and/or be programmed to implement a feedback controller, suchas a PID, state feedback, and adaptive controller. A power sourceconverts the signal from the feedback controller into a physical inputto the system: in this case the voltage. Other examples include a PWM ofthe voltage, current, and force. Other sensor(s) may be provided tomeasure physical parameters of the physical system in addition to theposition measured by the position sensor 472. In some aspects, the othersensor(s) can include sensor arrangements such as those described inU.S. Pat. No. 9,345,481, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM, which issued on May 24, 2016, which is herein incorporated byreference in its entirety; U.S. Patent Application Publication No.2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,which published on Sep. 18, 2014, which is herein incorporated byreference in its entirety; and U.S. patent application Ser. No.15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OFA SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, whichis herein incorporated by reference in its entirety. In a digital signalprocessing system, an absolute positioning system is coupled to adigital data acquisition system where the output of the absolutepositioning system will have a finite resolution and sampling frequency.The absolute positioning system may comprise a compare-and-combinecircuit to combine a computed response with a measured response usingalgorithms, such as a weighted average and a theoretical control loop,that drive the computed response towards the measured response. Thecomputed response of the physical system takes into account propertieslike mass, inertial, viscous friction, inductance resistance, etc., topredict what the states and outputs of the physical system will be byknowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power-up of the instrument, without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 482 has takento infer the position of a device actuator, drive bar, knife, or thelike.

A sensor 474, such as, for example, a strain gauge or a micro-straingauge, is configured to measure one or more parameters of the endeffector, such as, for example, the amplitude of the strain exerted onthe anvil during a clamping operation, which can be indicative of theclosure forces applied to the anvil. The measured strain is converted toa digital signal and provided to the processor 462. Alternatively, or inaddition to the sensor 474, a sensor 476, such as, for example, a loadsensor, can measure the closure force applied by the closure drivesystem to the anvil. The sensor 476, such as, for example, a loadsensor, can measure the firing force applied to an !-beam in a firingstroke of the surgical instrument or tool. The I-beam is configured toengage a wedge sled, which is configured to upwardly cam staple driversto force out staples into deforming contact with an anvil. The I-beamalso includes a sharpened cutting edge that can be used to sever tissueas the I-beam is advanced distally by the firing bar. Alternatively, acurrent sensor 478 can be employed to measure the current drawn by themotor 482. The force required to advance the firing member cancorrespond to the current drawn by the motor 482, for example. Themeasured force is converted to a digital signal and provided to theprocessor 462.

In one form, the strain gauge sensor 474 can be used to measure theforce applied to the tissue by the end effector. A strain gauge can becoupled to the end effector to measure the force on the tissue beingtreated by the end effector. A system for measuring forces applied tothe tissue grasped by the end effector comprises a strain gauge sensor474, such as, for example, a micro-strain gauge, that is configured tomeasure one or more parameters of the end effector, for example. In oneaspect, the strain gauge sensor 474 can measure the amplitude ormagnitude of the strain exerted on a jaw member of an end effectorduring a clamping operation, which can be indicative of the tissuecompression. The measured strain is converted to a digital signal andprovided to a processor 462 of the microcontroller 461. A load sensor476 can measure the force used to operate the knife element, forexample, to cut the tissue captured between the anvil and the staplecartridge. A magnetic field sensor can be employed to measure thethickness of the captured tissue. The measurement of the magnetic fieldsensor also may be converted to a digital signal and provided to theprocessor 462.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector on the tissue, asrespectively measured by the sensors 474, 476, can be used by themicrocontroller 461 to characterize the selected position of the firingmember and/or the corresponding value of the speed of the firing member.In one instance, a memory 468 may store a technique, an equation, and/ora lookup table which can be employed by the microcontroller 461 in theassessment.

The control system 470 of the surgical instrument or tool also maycomprise wired or wireless communication circuits to communicate withthe modular communication hub as shown in FIGS. 8-11 .

FIG. 13 illustrates a control circuit 500 configured to control aspectsof the surgical instrument or tool according to one aspect of thisdisclosure. The control circuit 500 can be configured to implementvarious processes described herein. The control circuit 500 may comprisea microcontroller comprising one or more processors 502 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit504. The memory circuit 504 stores machine-executable instructions that,when executed by the processor 502, cause the processor 502 to executemachine instructions to implement various processes described herein.The processor 502 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 504 may comprisevolatile and non-volatile storage media. The processor 502 may includean instruction processing unit 506 and an arithmetic unit 508. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 504 of this disclosure.

FIG. 14 illustrates a combinational logic circuit 510 configured tocontrol aspects of the surgical instrument or tool according to oneaspect of this disclosure. The combinational logic circuit 510 can beconfigured to implement various processes described herein. Thecombinational logic circuit 510 may comprise a finite state machinecomprising a combinational logic 512 configured to receive dataassociated with the surgical instrument or tool at an input 514, processthe data by the combinational logic 512, and provide an output 516.

FIG. 15 illustrates a sequential logic circuit 520 configured to controlaspects of the surgical instrument or tool according to one aspect ofthis disclosure. The sequential logic circuit 520 or the combinationallogic 522 can be configured to implement various processes describedherein. The sequential logic circuit 520 may comprise a finite statemachine. The sequential logic circuit 520 may comprise a combinationallogic 522, at least one memory circuit 524, and a clock 529, forexample. The at least one memory circuit 524 can store a current stateof the finite state machine. In certain instances, the sequential logiccircuit 520 may be synchronous or asynchronous. The combinational logic522 is configured to receive data associated with the surgicalinstrument or tool from an input 526, process the data by thecombinational logic 522, and provide an output 528. In other aspects,the circuit may comprise a combination of a processor (e.g., processor502, FIG. 13 ) and a finite state machine to implement various processesherein. In other aspects, the finite state machine may comprise acombination of a combinational logic circuit (e.g., combinational logiccircuit 510, FIG. 14 ) and the sequential logic circuit 520.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions. Incertain instances, a first motor can be activated to perform a firstfunction, a second motor can be activated to perform a second function,a third motor can be activated to perform a third function, a fourthmotor can be activated to perform a fourth function, and so on. Incertain instances, the plurality of motors of robotic surgicalinstrument 600 can be individually activated to cause firing, closure,and/or articulation motions in the end effector. The firing, closure,and/or articulation motions can be transmitted to the end effectorthrough a shaft assembly, for example.

In certain instances, the surgical instrument system or tool may includea firing motor 602. The firing motor 602 may be operably coupled to afiring motor drive assembly 604 which can be configured to transmitfiring motions, generated by the motor 602 to the end effector, inparticular to displace the I-beam element. In certain instances, thefiring motions generated by the motor 602 may cause the staples to bedeployed from the staple cartridge into tissue captured by the endeffector and/or the cutting edge of the I-beam element to be advanced tocut the captured tissue, for example. The I-beam element may beretracted by reversing the direction of the motor 602.

In certain instances, the surgical instrument or tool may include aclosure motor 603. The closure motor 603 may be operably coupled to aclosure motor drive assembly 605 which can be configured to transmitclosure motions, generated by the motor 603 to the end effector, inparticular to displace a closure tube to close the anvil and compresstissue between the anvil and the staple cartridge. The closure motionsmay cause the end effector to transition from an open configuration toan approximated configuration to capture tissue, for example. The endeffector may be transitioned to an open position by reversing thedirection of the motor 603.

In certain instances, the surgical instrument or tool may include one ormore articulation motors 606 a, 606 b, for example. The motors 606 a,606 b may be operably coupled to respective articulation motor driveassemblies 608 a, 608 b, which can be configured to transmitarticulation motions generated by the motors 606 a, 606 b to the endeffector. In certain instances, the articulation motions may cause theend effector to articulate relative to the shaft, for example.

As described above, the surgical instrument or tool may include aplurality of motors which may be configured to perform variousindependent functions. In certain instances, the plurality of motors ofthe surgical instrument or tool can be individually or separatelyactivated to perform one or more functions while the other motors remaininactive. For example, the articulation motors 606 a, 606 b can beactivated to cause the end effector to be articulated while the firingmotor 602 remains inactive. Alternatively, the firing motor 602 can beactivated to fire the plurality of staples, and/or to advance thecutting edge, while the articulation motor 606 remains inactive.Furthermore the closure motor 603 may be activated simultaneously withthe firing motor 602 to cause the closure tube and the I-beam element toadvance distally as described in more detail hereinbelow.

In certain instances, the surgical instrument or tool may include acommon control module 610 which can be employed with a plurality ofmotors of the surgical instrument or tool. In certain instances, thecommon control module 610 may accommodate one of the plurality of motorsat a time. For example, the common control module 610 can be couplableto and separable from the plurality of motors of the robotic surgicalinstrument individually. In certain instances, a plurality of the motorsof the surgical instrument or tool may share one or more common controlmodules such as the common control module 610. In certain instances, aplurality of motors of the surgical instrument or tool can beindividually and selectively engaged with the common control module 610.In certain instances, the common control module 610 can be selectivelyswitched from interfacing with one of a plurality of motors of thesurgical instrument or tool to interfacing with another one of theplurality of motors of the surgical instrument or tool.

In at least one example, the common control module 610 can beselectively switched between operable engagement with the articulationmotors 606 a, 606 b and operable engagement with either the firing motor602 or the closure motor 603. In at least one example, as illustrated inFIG. 16 , a switch 614 can be moved or transitioned between a pluralityof positions and/or states. In a first position 616, the switch 614 mayelectrically couple the common control module 610 to the firing motor602; in a second position 617, the switch 614 may electrically couplethe common control module 610 to the closure motor 603; in a thirdposition 618 a, the switch 614 may electrically couple the commoncontrol module 610 to the first articulation motor 606 a; and in afourth position 618 b, the switch 614 may electrically couple the commoncontrol module 610 to the second articulation motor 606 b, for example.In certain instances, separate common control modules 610 can beelectrically coupled to the firing motor 602, the closure motor 603, andthe articulations motor 606 a, 606 b at the same time. In certaininstances, the switch 614 may be a mechanical switch, anelectromechanical switch, a solid-state switch, or any suitableswitching mechanism.

Each of the motors 602, 603, 606 a, 606 b may comprise a torque sensorto measure the output torque on the shaft of the motor. The force on anend effector may be sensed in any conventional manner, such as by forcesensors on the outer sides of the jaws or by a torque sensor for themotor actuating the jaws.

In various instances, as illustrated in FIG. 16 , the common controlmodule 610 may comprise a motor driver 626 which may comprise one ormore H-Bridge FETs. The motor driver 626 may modulate the powertransmitted from a power source 628 to a motor coupled to the commoncontrol module 610 based on input from a microcontroller 620 (the“controller”), for example. In certain instances, the microcontroller620 can be employed to determine the current drawn by the motor, forexample, while the motor is coupled to the common control module 610, asdescribed above.

In certain instances, the microcontroller 620 may include amicroprocessor 622 (the “processor”) and one or more non-transitorycomputer-readable mediums or memory units 624 (the “memory”). In certaininstances, the memory 624 may store various program instructions, whichwhen executed may cause the processor 622 to perform a plurality offunctions and/or calculations described herein. In certain instances,one or more of the memory units 624 may be coupled to the processor 622,for example.

In certain instances, the power source 628 can be employed to supplypower to the microcontroller 620, for example. In certain instances, thepower source 628 may comprise a battery (or “battery pack” or “powerpack”), such as a lithium-ion battery, for example. In certaininstances, the battery pack may be configured to be releasably mountedto a handle for supplying power to the surgical instrument 600. A numberof battery cells connected in series may be used as the power source628. In certain instances, the power source 628 may be replaceableand/or rechargeable, for example.

In various instances, the processor 622 may control the motor driver 626to control the position, direction of rotation, and/or velocity of amotor that is coupled to the common control module 610. In certaininstances, the processor 622 can signal the motor driver 626 to stopand/or disable a motor that is coupled to the common control module 610.It should be understood that the term “processor” as used hereinincludes any suitable microprocessor, microcontroller, or other basiccomputing device that incorporates the functions of a computer's centralprocessing unit (CPU) on an integrated circuit or, at most, a fewintegrated circuits. The processor is a multipurpose, programmabledevice that accepts digital data as input, processes it according toinstructions stored in its memory, and provides results as output. It isan example of sequential digital logic, as it has internal memory.Processors operate on numbers and symbols represented in the binarynumeral system.

In one instance, the processor 622 may be any single-core or multicoreprocessor such as those known under the trade name ARM Cortex by TexasInstruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at leastone example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4FProcessor Core comprising an on-chip memory of 256 KB single-cycle flashmemory, or other non-volatile memory, up to 40 MHz, a prefetch buffer toimprove performance above 40 MHz, a 32 KB single-cycle SRAM, an internalROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWMmodules, one or more QEI analogs, one or more 12-bit ADCs with 12 analoginput channels, among other features that are readily available for theproduct datasheet. Other microcontrollers may be readily substituted foruse with the module 4410. Accordingly, the present disclosure should notbe limited in this context.

In certain instances, the memory 624 may include program instructionsfor controlling each of the motors of the surgical instrument 600 thatare couplable to the common control module 610. For example, the memory624 may include program instructions for controlling the firing motor602, the closure motor 603, and the articulation motors 606 a, 606 b.Such program instructions may cause the processor 622 to control thefiring, closure, and articulation functions in accordance with inputsfrom algorithms or control programs of the surgical instrument or tool.

In certain instances, one or more mechanisms and/or sensors such as, forexample, sensors 630 can be employed to alert the processor 622 to theprogram instructions that should be used in a particular setting. Forexample, the sensors 630 may alert the processor 622 to use the programinstructions associated with firing, closing, and articulating the endeffector. In certain instances, the sensors 630 may comprise positionsensors which can be employed to sense the position of the switch 614,for example. Accordingly, the processor 622 may use the programinstructions associated with firing the I-beam of the end effector upondetecting, through the sensors 630 for example, that the switch 614 isin the first position 616; the processor 622 may use the programinstructions associated with closing the anvil upon detecting, throughthe sensors 630 for example, that the switch 614 is in the secondposition 617; and the processor 622 may use the program instructionsassociated with articulating the end effector upon detecting, throughthe sensors 630 for example, that the switch 614 is in the third orfourth position 618 a, 618 b.

FIG. 17 is a schematic diagram of a robotic surgical instrument 700configured to operate a surgical tool described herein according to oneaspect of this disclosure. The robotic surgical instrument 700 may beprogrammed or configured to control distal/proximal translation of adisplacement member, distal/proximal displacement of a closure tube,shaft rotation, and articulation, either with single or multiplearticulation drive links. In one aspect, the surgical instrument 700 maybe programmed or configured to individually control a firing member, aclosure member, a shaft member, and/or one or more articulation members.The surgical instrument 700 comprises a control circuit 710 configuredto control motor-driven firing members, closure members, shaft members,and/or one or more articulation members.

In one aspect, the robotic surgical instrument 700 comprises a controlcircuit 710 configured to control an anvil 716 and an I-beam 714(including a sharp cutting edge) portion of an end effector 702, aremovable staple cartridge 718, a shaft 740, and one or morearticulation members 742 a, 742 b via a plurality of motors 704 a-704 e.A position sensor 734 may be configured to provide position feedback ofthe I-beam 714 to the control circuit 710. Other sensors 738 may beconfigured to provide feedback to the control circuit 710. Atimer/counter 731 provides timing and counting information to thecontrol circuit 710. An energy source 712 may be provided to operate themotors 704 a-704 e, and a current sensor 736 provides motor currentfeedback to the control circuit 710. The motors 704 a-704 e can beoperated individually by the control circuit 710 in an open-loop orclosed-loop feedback control.

In one aspect, the control circuit 710 may comprise one or moremicrocontrollers, microprocessors, or other suitable processors forexecuting instructions that cause the processor or processors to performone or more tasks. In one aspect, a timer/counter 731 provides an outputsignal, such as the elapsed time or a digital count, to the controlcircuit 710 to correlate the position of the I-beam 714 as determined bythe position sensor 734 with the output of the timer/counter 731 suchthat the control circuit 710 can determine the position of the I-beam714 at a specific time (t) relative to a starting position or the time(t) when the I-beam 714 is at a specific position relative to a startingposition. The timer/counter 731 may be configured to measure elapsedtime, count external events, or time external events.

In one aspect, the control circuit 710 may be programmed to controlfunctions of the end effector 702 based on one or more tissueconditions. The control circuit 710 may be programmed to sense tissueconditions, such as thickness, either directly or indirectly, asdescribed herein. The control circuit 710 may be programmed to select afiring control program or closure control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 710 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 710 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power. A closure control program may control theclosure force applied to the tissue by the anvil 716. Other controlprograms control the rotation of the shaft 740 and the articulationmembers 742 a, 742 b.

In one aspect, the control circuit 710 may generate motor set pointsignals. The motor set point signals may be provided to various motorcontrollers 708 a-708 e. The motor controllers 708 a-708 e may compriseone or more circuits configured to provide motor drive signals to themotors 704 a-704 e to drive the motors 704 a-704 e as described herein.In some examples, the motors 704 a-704 e may be brushed DC electricmotors. For example, the velocity of the motors 704 a-704 e may beproportional to the respective motor drive signals. In some examples,the motors 704 a-704 e may be brushless DC electric motors, and therespective motor drive signals may comprise a PWM signal provided to oneor more stator windings of the motors 704 a-704 e. Also, in someexamples, the motor controllers 708 a-708 e may be omitted and thecontrol circuit 710 may generate the motor drive signals directly.

In one aspect, the control circuit 710 may initially operate each of themotors 704 a-704 e in an open-loop configuration for a first open-loopportion of a stroke of the displacement member. Based on the response ofthe robotic surgical instrument 700 during the open-loop portion of thestroke, the control circuit 710 may select a firing control program in aclosed-loop configuration. The response of the instrument may include atranslation distance of the displacement member during the open-loopportion, a time elapsed during the open-loop portion, the energyprovided to one of the motors 704 a-704 e during the open-loop portion,a sum of pulse widths of a motor drive signal, etc. After the open-loopportion, the control circuit 710 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during a closed-loop portion of the stroke, the controlcircuit 710 may modulate one of the motors 704 a-704 e based ontranslation data describing a position of the displacement member in aclosed-loop manner to translate the displacement member at a constantvelocity.

In one aspect, the motors 704 a-704 e may receive power from an energysource 712. The energy source 712 may be a DC power supply driven by amain alternating current power source, a battery, a super capacitor, orany other suitable energy source. The motors 704 a-704 e may bemechanically coupled to individual movable mechanical elements such asthe I-beam 714, anvil 716, shaft 740, articulation 742 a, andarticulation 742 b via respective transmissions 706 a-706 e. Thetransmissions 706 a-706 e may include one or more gears or other linkagecomponents to couple the motors 704 a-704 e to movable mechanicalelements. A position sensor 734 may sense a position of the I-beam 714.The position sensor 734 may be or include any type of sensor that iscapable of generating position data that indicate a position of theI-beam 714. In some examples, the position sensor 734 may include anencoder configured to provide a series of pulses to the control circuit710 as the I-beam 714 translates distally and proximally. The controlcircuit 710 may track the pulses to determine the position of the I-beam714. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 714. Also, in someexamples, the position sensor 734 may be omitted. Where any of themotors 704 a-704 e is a stepper motor, the control circuit 710 may trackthe position of the I-beam 714 by aggregating the number and directionof steps that the motor 704 has been instructed to execute. The positionsensor 734 may be located in the end effector 702 or at any otherportion of the instrument. The outputs of each of the motors 704 a-704 einclude a torque sensor 744 a-744 e to sense force and have an encoderto sense rotation of the drive shaft.

In one aspect, the control circuit 710 is configured to drive a firingmember such as the I-beam 714 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 a,which provides a drive signal to the motor 704 a. The output shaft ofthe motor 704 a is coupled to a torque sensor 744 a. The torque sensor744 a is coupled to a transmission 706 a which is coupled to the I-beam714. The transmission 706 a comprises movable mechanical elements suchas rotating elements and a firing member to control the movement of theI-beam 714 distally and proximally along a longitudinal axis of the endeffector 702. In one aspect, the motor 704 a may be coupled to the knifegear assembly, which includes a knife gear reduction set that includes afirst knife drive gear and a second knife drive gear. A torque sensor744 a provides a firing force feedback signal to the control circuit710. The firing force signal represents the force required to fire ordisplace the I-beam 714. A position sensor 734 may be configured toprovide the position of the I-beam 714 along the firing stroke or theposition of the firing member as a feedback signal to the controlcircuit 710. The end effector 702 may include additional sensors 738configured to provide feedback signals to the control circuit 710. Whenready to use, the control circuit 710 may provide a firing signal to themotor control 708 a. In response to the firing signal, the motor 704 amay drive the firing member distally along the longitudinal axis of theend effector 702 from a proximal stroke start position to a stroke endposition distal to the stroke start position. As the firing membertranslates distally, an I-beam 714, with a cutting element positioned ata distal end, advances distally to cut tissue located between the staplecartridge 718 and the anvil 716.

In one aspect, the control circuit 710 is configured to drive a closuremember such as the anvil 716 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 b,which provides a drive signal to the motor 704 b. The output shaft ofthe motor 704 b is coupled to a torque sensor 744 b. The torque sensor744 b is coupled to a transmission 706 b which is coupled to the anvil716. The transmission 706 b comprises movable mechanical elements suchas rotating elements and a closure member to control the movement of theanvil 716 from the open and closed positions. In one aspect, the motor704 b is coupled to a closure gear assembly, which includes a closurereduction gear set that is supported in meshing engagement with theclosure spur gear. The torque sensor 744 b provides a closure forcefeedback signal to the control circuit 710. The closure force feedbacksignal represents the closure force applied to the anvil 716. Theposition sensor 734 may be configured to provide the position of theclosure member as a feedback signal to the control circuit 710.Additional sensors 738 in the end effector 702 may provide the closureforce feedback signal to the control circuit 710. The pivotable anvil716 is positioned opposite the staple cartridge 718. When ready to use,the control circuit 710 may provide a closure signal to the motorcontrol 708 b. In response to the closure signal, the motor 704 badvances a closure member to grasp tissue between the anvil 716 and thestaple cartridge 718.

In one aspect, the control circuit 710 is configured to rotate a shaftmember such as the shaft 740 to rotate the end effector 702. The controlcircuit 710 provides a motor set point to a motor control 708 c, whichprovides a drive signal to the motor 704 c. The output shaft of themotor 704 c is coupled to a torque sensor 744 c. The torque sensor 744 cis coupled to a transmission 706 c which is coupled to the shaft 740.The transmission 706 c comprises movable mechanical elements such asrotating elements to control the rotation of the shaft 740 clockwise orcounterclockwise up to and over 360°. In one aspect, the motor 704 c iscoupled to the rotational transmission assembly, which includes a tubegear segment that is formed on (or attached to) the proximal end of theproximal closure tube for operable engagement by a rotational gearassembly that is operably supported on the tool mounting plate. Thetorque sensor 744 c provides a rotation force feedback signal to thecontrol circuit 710. The rotation force feedback signal represents therotation force applied to the shaft 740. The position sensor 734 may beconfigured to provide the position of the closure member as a feedbacksignal to the control circuit 710. Additional sensors 738 such as ashaft encoder may provide the rotational position of the shaft 740 tothe control circuit 710.

In one aspect, the control circuit 710 is configured to articulate theend effector 702. The control circuit 710 provides a motor set point toa motor control 708 d, which provides a drive signal to the motor 704 d.The output shaft of the motor 704 d is coupled to a torque sensor 744 d.The torque sensor 744 d is coupled to a transmission 706 d which iscoupled to an articulation member 742 a. The transmission 706 dcomprises movable mechanical elements such as articulation elements tocontrol the articulation of the end effector 702±65°. In one aspect, themotor 704 d is coupled to an articulation nut, which is rotatablyjournaled on the proximal end portion of the distal spine portion and isrotatably driven thereon by an articulation gear assembly. The torquesensor 744 d provides an articulation force feedback signal to thecontrol circuit 710. The articulation force feedback signal representsthe articulation force applied to the end effector 702. Sensors 738,such as an articulation encoder, may provide the articulation positionof the end effector 702 to the control circuit 710.

In another aspect, the articulation function of the robotic surgicalsystem 700 may comprise two articulation members, or links, 742 a, 742b. These articulation members 742 a, 742 b are driven by separate diskson the robot interface (the rack) which are driven by the two motors 708d, 708 e. When the separate firing motor 704 a is provided, each ofarticulation links 742 a, 742 b can be antagonistically driven withrespect to the other link in order to provide a resistive holding motionand a load to the head when it is not moving and to provide anarticulation motion as the head is articulated. The articulation members742 a, 742 b attach to the head at a fixed radius as the head isrotated. Accordingly, the mechanical advantage of the push-and-pull linkchanges as the head is rotated. This change in the mechanical advantagemay be more pronounced with other articulation link drive systems.

In one aspect, the one or more motors 704 a-704 e may comprise a brushedDC motor with a gearbox and mechanical links to a firing member, closuremember, or articulation member. Another example includes electric motors704 a-704 e that operate the movable mechanical elements such as thedisplacement member, articulation links, closure tube, and shaft. Anoutside influence is an unmeasured, unpredictable influence of thingslike tissue, surrounding bodies, and friction on the physical system.Such outside influence can be referred to as drag, which acts inopposition to one of electric motors 704 a-704 e. The outside influence,such as drag, may cause the operation of the physical system to deviatefrom a desired operation of the physical system.

In one aspect, the position sensor 734 may be implemented as an absolutepositioning system. In one aspect, the position sensor 734 may comprisea magnetic rotary absolute positioning system implemented as anAS5055EQFT single-chip magnetic rotary position sensor available fromAustria Microsystems, AG. The position sensor 734 may interface with thecontrol circuit 710 to provide an absolute positioning system. Theposition may include multiple Hall-effect elements located above amagnet and coupled to a CORDIC processor, also known as thedigit-by-digit method and Volder's algorithm, that is provided toimplement a simple and efficient algorithm to calculate hyperbolic andtrigonometric functions that require only addition, subtraction,bitshift, and table lookup operations.

In one aspect, the control circuit 710 may be in communication with oneor more sensors 738. The sensors 738 may be positioned on the endeffector 702 and adapted to operate with the robotic surgical instrument700 to measure the various derived parameters such as the gap distanceversus time, tissue compression versus time, and anvil strain versustime. The sensors 738 may comprise a magnetic sensor, a magnetic fieldsensor, a strain gauge, a load cell, a pressure sensor, a force sensor,a torque sensor, an inductive sensor such as an eddy current sensor, aresistive sensor, a capacitive sensor, an optical sensor, and/or anyother suitable sensor for measuring one or more parameters of the endeffector 702. The sensors 738 may include one or more sensors. Thesensors 738 may be located on the staple cartridge 718 deck to determinetissue location using segmented electrodes. The torque sensors 744 a-744e may be configured to sense force such as firing force, closure force,and/or articulation force, among others. Accordingly, the controlcircuit 710 can sense (1) the closure load experienced by the distalclosure tube and its position, (2) the firing member at the rack and itsposition, (3) what portion of the staple cartridge 718 has tissue on it,and (4) the load and position on both articulation rods.

In one aspect, the one or more sensors 738 may comprise a strain gauge,such as a micro-strain gauge, configured to measure the magnitude of thestrain in the anvil 716 during a clamped condition. The strain gaugeprovides an electrical signal whose amplitude varies with the magnitudeof the strain. The sensors 738 may comprise a pressure sensor configuredto detect a pressure generated by the presence of compressed tissuebetween the anvil 716 and the staple cartridge 718. The sensors 738 maybe configured to detect impedance of a tissue section located betweenthe anvil 716 and the staple cartridge 718 that is indicative of thethickness and/or fullness of tissue located therebetween.

In one aspect, the sensors 738 may be implemented as one or more limitswitches, electromechanical devices, solid-state switches, Hall-effectdevices, magneto-resistive (MR) devices, giant magneto-resistive (GMR)devices, magnetometers, among others. In other implementations, thesensors 738 may be implemented as solid-state switches that operateunder the influence of light, such as optical sensors, IR sensors,ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors738 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the sensors 738 may be configured to measure forcesexerted on the anvil 716 by the closure drive system. For example, oneor more sensors 738 can be at an interaction point between the closuretube and the anvil 716 to detect the closure forces applied by theclosure tube to the anvil 716. The forces exerted on the anvil 716 canbe representative of the tissue compression experienced by the tissuesection captured between the anvil 716 and the staple cartridge 718. Theone or more sensors 738 can be positioned at various interaction pointsalong the closure drive system to detect the closure forces applied tothe anvil 716 by the closure drive system. The one or more sensors 738may be sampled in real time during a clamping operation by the processorof the control circuit 710. The control circuit 710 receives real-timesample measurements to provide and analyze time-based information andassess, in real time, closure forces applied to the anvil 716.

In one aspect, a current sensor 736 can be employed to measure thecurrent drawn by each of the motors 704 a-704 e. The force required toadvance any of the movable mechanical elements such as the I-beam 714corresponds to the current drawn by one of the motors 704 a-704 e. Theforce is converted to a digital signal and provided to the controlcircuit 710. The control circuit 710 can be configured to simulate theresponse of the actual system of the instrument in the software of thecontroller. A displacement member can be actuated to move an I-beam 714in the end effector 702 at or near a target velocity. The roboticsurgical instrument 700 can include a feedback controller, which can beone of any feedback controllers, including, but not limited to a PID, astate feedback, a linear-quadratic (LQR), and/or an adaptive controller,for example. The robotic surgical instrument 700 can include a powersource to convert the signal from the feedback controller into aphysical input such as case voltage, PWM voltage, frequency modulatedvoltage, current, torque, and/or force, for example. Additional detailsare disclosed in U.S. patent application Ser. No. 15/636,829, titledCLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT,filed Jun. 29, 2017, which is herein incorporated by reference in itsentirety.

FIG. 18 illustrates a block diagram of a surgical instrument 750programmed to control the distal translation of a displacement memberaccording to one aspect of this disclosure. In one aspect, the surgicalinstrument 750 is programmed to control the distal translation of adisplacement member such as the I-beam 764. The surgical instrument 750comprises an end effector 752 that may comprise an anvil 766, an !-beam764 (including a sharp cutting edge), and a removable staple cartridge768.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensor784. Because the I-beam 764 is coupled to a longitudinally movable drivemember, the position of the I-beam 764 can be determined by measuringthe position of the longitudinally movable drive member employing theposition sensor 784. Accordingly, in the following description, theposition, displacement, and/or translation of the I-beam 764 can beachieved by the position sensor 784 as described herein. A controlcircuit 760 may be programmed to control the translation of thedisplacement member, such as the I-beam 764. The control circuit 760, insome examples, may comprise one or more microcontrollers,microprocessors, or other suitable processors for executing instructionsthat cause the processor or processors to control the displacementmember, e.g., the I-beam 764, in the manner described. In one aspect, atimer/counter 781 provides an output signal, such as the elapsed time ora digital count, to the control circuit 760 to correlate the position ofthe I-beam 764 as determined by the position sensor 784 with the outputof the timer/counter 781 such that the control circuit 760 can determinethe position of the I-beam 764 at a specific time (t) relative to astarting position. The timer/counter 781 may be configured to measureelapsed time, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of the!-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor 754 has been instructed to execute. The position sensor 784 may belocated in the end effector 752 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 752 andadapted to operate with the surgical instrument 750 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 752. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be is configured to measure forces exerted on theanvil 766 by a closure drive system. For example, one or more sensors788 can be at an interaction point between a closure tube and the anvil766 to detect the closure forces applied by a closure tube to the anvil766. The forces exerted on the anvil 766 can be representative of thetissue compression experienced by the tissue section captured betweenthe anvil 766 and the staple cartridge 768. The one or more sensors 788can be positioned at various interaction points along the closure drivesystem to detect the closure forces applied to the anvil 766 by theclosure drive system. The one or more sensors 788 may be sampled in realtime during a clamping operation by a processor of the control circuit760. The control circuit 760 receives real-time sample measurements toprovide and analyze time-based information and assess, in real time,closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

The control circuit 760 can be configured to simulate the response ofthe actual system of the instrument in the software of the controller. Adisplacement member can be actuated to move an I-beam 764 in the endeffector 752 at or near a target velocity. The surgical instrument 750can include a feedback controller, which can be one of any feedbackcontrollers, including, but not limited to a PID, a state feedback, LQR,and/or an adaptive controller, for example. The surgical instrument 750can include a power source to convert the signal from the feedbackcontroller into a physical input such as case voltage, PWM voltage,frequency modulated voltage, current, torque, and/or force, for example.

The actual drive system of the surgical instrument 750 is configured todrive the displacement member, cutting member, or I-beam 764, by abrushed DC motor with gearbox and mechanical links to an articulationand/or knife system. Another example is the electric motor 754 thatoperates the displacement member and the articulation driver, forexample, of an interchangeable shaft assembly. An outside influence isan unmeasured, unpredictable influence of things like tissue,surrounding bodies and friction on the physical system. Such outsideinfluence can be referred to as drag which acts in opposition to theelectric motor 754. The outside influence, such as drag, may cause theoperation of the physical system to deviate from a desired operation ofthe physical system.

Various example aspects are directed to a surgical instrument 750comprising an end effector 752 with motor-driven surgical stapling andcutting implements. For example, a motor 754 may drive a displacementmember distally and proximally along a longitudinal axis of the endeffector 752. The end effector 752 may comprise a pivotable anvil 766and, when configured for use, a staple cartridge 768 positioned oppositethe anvil 766. A clinician may grasp tissue between the anvil 766 andthe staple cartridge 768, as described herein. When ready to use theinstrument 750, the clinician may provide a firing signal, for exampleby depressing a trigger of the instrument 750. In response to the firingsignal, the motor 754 may drive the displacement member distally alongthe longitudinal axis of the end effector 752 from a proximal strokebegin position to a stroke end position distal of the stroke beginposition. As the displacement member translates distally, an I-beam 764with a cutting element positioned at a distal end, may cut the tissuebetween the staple cartridge 768 and the anvil 766.

In various examples, the surgical instrument 750 may comprise a controlcircuit 760 programmed to control the distal translation of thedisplacement member, such as the I-beam 764, for example, based on oneor more tissue conditions. The control circuit 760 may be programmed tosense tissue conditions, such as thickness, either directly orindirectly, as described herein. The control circuit 760 may beprogrammed to select a firing control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 760 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 760 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power.

In some examples, the control circuit 760 may initially operate themotor 754 in an open loop configuration for a first open loop portion ofa stroke of the displacement member. Based on a response of theinstrument 750 during the open loop portion of the stroke, the controlcircuit 760 may select a firing control program. The response of theinstrument may include, a translation distance of the displacementmember during the open loop portion, a time elapsed during the open loopportion, energy provided to the motor 754 during the open loop portion,a sum of pulse widths of a motor drive signal, etc. After the open loopportion, the control circuit 760 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during the closed loop portion of the stroke, the controlcircuit 760 may modulate the motor 754 based on translation datadescribing a position of the displacement member in a closed loop mannerto translate the displacement member at a constant velocity. Additionaldetails are disclosed in U.S. patent application Ser. No. 15/720,852,titled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICALINSTRUMENT, filed Sep. 29, 2017, which is herein incorporated byreference in its entirety.

FIG. 19 is a schematic diagram of a surgical instrument 790 configuredto control various functions according to one aspect of this disclosure.In one aspect, the surgical instrument 790 is programmed to controldistal translation of a displacement member such as the I-beam 764. Thesurgical instrument 790 comprises an end effector 792 that may comprisean anvil 766, an I-beam 764, and a removable staple cartridge 768 whichmay be interchanged with an RF cartridge 796 (shown in dashed line).

In one aspect, sensors 788 may be implemented as a limit switch,electromechanical device, solid-state switches, Hall-effect devices, MRdevices, GMR devices, magnetometers, among others. In otherimplementations, the sensors 638 may be solid-state switches thatoperate under the influence of light, such as optical sensors, IRsensors, ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors788 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the position sensor 784 may be implemented as an absolutepositioning system comprising a magnetic rotary absolute positioningsystem implemented as an AS5055EQFT single-chip magnetic rotary positionsensor available from Austria Microsystems, AG. The position sensor 784may interface with the control circuit 760 to provide an absolutepositioning system. The position may include multiple Hall-effectelements located above a magnet and coupled to a CORDIC processor, alsoknown as the digit-by-digit method and Volder's algorithm, that isprovided to implement a simple and efficient algorithm to calculatehyperbolic and trigonometric functions that require only addition,subtraction, bitshift, and table lookup operations.

In one aspect, the I-beam 764 may be implemented as a knife membercomprising a knife body that operably supports a tissue cutting bladethereon and may further include anvil engagement tabs or features andchannel engagement features or a foot. In one aspect, the staplecartridge 768 may be implemented as a standard (mechanical) surgicalfastener cartridge. In one aspect, the RF cartridge 796 may beimplemented as an RF cartridge. These and other sensors arrangements aredescribed in commonly owned U.S. patent application Ser. No. 15/628,175,titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICALSTAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is hereinincorporated by reference in its entirety.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensorrepresented as position sensor 784. Because the I-beam 764 is coupled tothe longitudinally movable drive member, the position of the I-beam 764can be determined by measuring the position of the longitudinallymovable drive member employing the position sensor 784. Accordingly, inthe following description, the position, displacement, and/ortranslation of the I-beam 764 can be achieved by the position sensor 784as described herein. A control circuit 760 may be programmed to controlthe translation of the displacement member, such as the I-beam 764, asdescribed herein. The control circuit 760, in some examples, maycomprise one or more microcontrollers, microprocessors, or othersuitable processors for executing instructions that cause the processoror processors to control the displacement member, e.g., the I-beam 764,in the manner described. In one aspect, a timer/counter 781 provides anoutput signal, such as the elapsed time or a digital count, to thecontrol circuit 760 to correlate the position of the I-beam 764 asdetermined by the position sensor 784 with the output of thetimer/counter 781 such that the control circuit 760 can determine theposition of the I-beam 764 at a specific time (t) relative to a startingposition. The timer/counter 781 may be configured to measure elapsedtime, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of theI-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor has been instructed to execute. The position sensor 784 may belocated in the end effector 792 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 792 andadapted to operate with the surgical instrument 790 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 792. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be is configured to measure forces exerted on theanvil 766 by the closure drive system. For example, one or more sensors788 can be at an interaction point between a closure tube and the anvil766 to detect the closure forces applied by a closure tube to the anvil766. The forces exerted on the anvil 766 can be representative of thetissue compression experienced by the tissue section captured betweenthe anvil 766 and the staple cartridge 768. The one or more sensors 788can be positioned at various interaction points along the closure drivesystem to detect the closure forces applied to the anvil 766 by theclosure drive system. The one or more sensors 788 may be sampled in realtime during a clamping operation by a processor portion of the controlcircuit 760. The control circuit 760 receives real-time samplemeasurements to provide and analyze time-based information and assess,in real time, closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

An RF energy source 794 is coupled to the end effector 792 and isapplied to the RF cartridge 796 when the RF cartridge 796 is loaded inthe end effector 792 in place of the staple cartridge 768. The controlcircuit 760 controls the delivery of the RF energy to the RF cartridge796.

Additional details are disclosed in U.S. patent application Ser. No.15/636,096, titled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE ANDRADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed Jun. 28,2017, which is herein incorporated by reference in its entirety.

FIG. 20 is a simplified block diagram of a generator 800 configured toprovide inductorless tuning, among other benefits. Additional details ofthe generator 800 are described in U.S. Pat. No. 9,060,775, titledSURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, whichissued on Jun. 23, 2015, which is herein incorporated by reference inits entirety. The generator 800 may comprise a patient isolated stage802 in communication with a non-isolated stage 804 via a powertransformer 806. A secondary winding 808 of the power transformer 806 iscontained in the isolated stage 802 and may comprise a tappedconfiguration (e.g., a center-tapped or a non-center-tappedconfiguration) to define drive signal outputs 810 a, 810 b, 810 c fordelivering drive signals to different surgical instruments, such as, forexample, an ultrasonic surgical instrument, an RF electrosurgicalinstrument, and a multifunction surgical instrument which includesultrasonic and RF energy modes that can be delivered alone orsimultaneously. In particular, drive signal outputs 810 a, 810 c mayoutput an ultrasonic drive signal (e.g., a 420V root-mean-square (RMS)drive signal) to an ultrasonic surgical instrument, and drive signaloutputs 810 b, 810 c may output an RF electrosurgical drive signal(e.g., a 100V RMS drive signal) to an RF electrosurgical instrument,with the drive signal output 810 b corresponding to the center tap ofthe power transformer 806.

In certain forms, the ultrasonic and electrosurgical drive signals maybe provided simultaneously to distinct surgical instruments and/or to asingle surgical instrument, such as the multifunction surgicalinstrument, having the capability to deliver both ultrasonic andelectrosurgical energy to tissue. It will be appreciated that theelectrosurgical signal, provided either to a dedicated electrosurgicalinstrument and/or to a combined multifunction ultrasonic/electrosurgicalinstrument may be either a therapeutic or sub-therapeutic level signalwhere the sub-therapeutic signal can be used, for example, to monitortissue or instrument conditions and provide feedback to the generator.For example, the ultrasonic and RF signals can be delivered separatelyor simultaneously from a generator with a single output port in order toprovide the desired output signal to the surgical instrument, as will bediscussed in more detail below. Accordingly, the generator can combinethe ultrasonic and electrosurgical RF energies and deliver the combinedenergies to the multifunction ultrasonic/electrosurgical instrument.Bipolar electrodes can be placed on one or both jaws of the endeffector. One jaw may be driven by ultrasonic energy in addition toelectrosurgical RF energy, working simultaneously. The ultrasonic energymay be employed to dissect tissue, while the electrosurgical RF energymay be employed for vessel sealing.

The non-isolated stage 804 may comprise a power amplifier 812 having anoutput connected to a primary winding 814 of the power transformer 806.In certain forms, the power amplifier 812 may comprise a push-pullamplifier. For example, the non-isolated stage 804 may further comprisea logic device 816 for supplying a digital output to a digital-to-analogconverter (DAC) circuit 818, which in turn supplies a correspondinganalog signal to an input of the power amplifier 812. In certain forms,the logic device 816 may comprise a programmable gate array (PGA), aFPGA, programmable logic device (PLD), among other logic circuits, forexample. The logic device 816, by virtue of controlling the input of thepower amplifier 812 via the DAC circuit 818, may therefore control anyof a number of parameters (e.g., frequency, waveform shape, waveformamplitude) of drive signals appearing at the drive signal outputs 810 a,810 b, 810 c. In certain forms and as discussed below, the logic device816, in conjunction with a processor (e.g., a DSP discussed below), mayimplement a number of DSP-based and/or other control algorithms tocontrol parameters of the drive signals output by the generator 800.

Power may be supplied to a power rail of the power amplifier 812 by aswitch-mode regulator 820, e.g., a power converter. In certain forms,the switch-mode regulator 820 may comprise an adjustable buck regulator,for example. The non-isolated stage 804 may further comprise a firstprocessor 822, which in one form may comprise a DSP processor such as anAnalog Devices ADSP-21469 SHARC DSP, available from Analog Devices,Norwood, Mass., for example, although in various forms any suitableprocessor may be employed. In certain forms the DSP processor 822 maycontrol the operation of the switch-mode regulator 820 responsive tovoltage feedback data received from the power amplifier 812 by the DSPprocessor 822 via an ADC circuit 824. In one form, for example, the DSPprocessor 822 may receive as input, via the ADC circuit 824, thewaveform envelope of a signal (e.g., an RF signal) being amplified bythe power amplifier 812. The DSP processor 822 may then control theswitch-mode regulator 820 (e.g., via a PWM output) such that the railvoltage supplied to the power amplifier 812 tracks the waveform envelopeof the amplified signal. By dynamically modulating the rail voltage ofthe power amplifier 812 based on the waveform envelope, the efficiencyof the power amplifier 812 may be significantly improved relative to afixed rail voltage amplifier schemes.

In certain forms, the logic device 816, in conjunction with the DSPprocessor 822, may implement a digital synthesis circuit such as adirect digital synthesizer control scheme to control the waveform shape,frequency, and/or amplitude of drive signals output by the generator800. In one form, for example, the logic device 816 may implement a DDScontrol algorithm by recalling waveform samples stored in a dynamicallyupdated lookup table (LUT), such as a RAM LUT, which may be embedded inan FPGA. This control algorithm is particularly useful for ultrasonicapplications in which an ultrasonic transducer, such as an ultrasonictransducer, may be driven by a clean sinusoidal current at its resonantfrequency. Because other frequencies may excite parasitic resonances,minimizing or reducing the total distortion of the motional branchcurrent may correspondingly minimize or reduce undesirable resonanceeffects. Because the waveform shape of a drive signal output by thegenerator 800 is impacted by various sources of distortion present inthe output drive circuit (e.g., the power transformer 806, the poweramplifier 812), voltage and current feedback data based on the drivesignal may be input into an algorithm, such as an error controlalgorithm implemented by the DSP processor 822, which compensates fordistortion by suitably pre-distorting or modifying the waveform samplesstored in the LUT on a dynamic, ongoing basis (e.g., in real time). Inone form, the amount or degree of pre-distortion applied to the LUTsamples may be based on the error between a computed motional branchcurrent and a desired current waveform shape, with the error beingdetermined on a sample-by-sample basis. In this way, the pre-distortedLUT samples, when processed through the drive circuit, may result in amotional branch drive signal having the desired waveform shape (e.g.,sinusoidal) for optimally driving the ultrasonic transducer. In suchforms, the LUT waveform samples will therefore not represent the desiredwaveform shape of the drive signal, but rather the waveform shape thatis required to ultimately produce the desired waveform shape of themotional branch drive signal when distortion effects are taken intoaccount.

The non-isolated stage 804 may further comprise a first ADC circuit 826and a second ADC circuit 828 coupled to the output of the powertransformer 806 via respective isolation transformers 830, 832 forrespectively sampling the voltage and current of drive signals output bythe generator 800. In certain forms, the ADC circuits 826, 828 may beconfigured to sample at high speeds (e.g., 80 mega samples per second(MSPS)) to enable oversampling of the drive signals. In one form, forexample, the sampling speed of the ADC circuits 826, 828 may enableapproximately 200× (depending on frequency) oversampling of the drivesignals. In certain forms, the sampling operations of the ADC circuit826, 828 may be performed by a single ADC circuit receiving inputvoltage and current signals via a two-way multiplexer. The use ofhigh-speed sampling in forms of the generator 800 may enable, amongother things, calculation of the complex current flowing through themotional branch (which may be used in certain forms to implementDDS-based waveform shape control described above), accurate digitalfiltering of the sampled signals, and calculation of real powerconsumption with a high degree of precision. Voltage and currentfeedback data output by the ADC circuits 826, 828 may be received andprocessed (e.g., first-in-first-out (FIFO) buffer, multiplexer) by thelogic device 816 and stored in data memory for subsequent retrieval by,for example, the DSP processor 822. As noted above, voltage and currentfeedback data may be used as input to an algorithm for pre-distorting ormodifying LUT waveform samples on a dynamic and ongoing basis. Incertain forms, this may require each stored voltage and current feedbackdata pair to be indexed based on, or otherwise associated with, acorresponding LUT sample that was output by the logic device 816 whenthe voltage and current feedback data pair was acquired. Synchronizationof the LUT samples and the voltage and current feedback data in thismanner contributes to the correct timing and stability of thepre-distortion algorithm.

In certain forms, the voltage and current feedback data may be used tocontrol the frequency and/or amplitude (e.g., current amplitude) of thedrive signals. In one form, for example, voltage and current feedbackdata may be used to determine impedance phase. The frequency of thedrive signal may then be controlled to minimize or reduce the differencebetween the determined impedance phase and an impedance phase setpoint(e.g., 0°), thereby minimizing or reducing the effects of harmonicdistortion and correspondingly enhancing impedance phase measurementaccuracy. The determination of phase impedance and a frequency controlsignal may be implemented in the DSP processor 822, for example, withthe frequency control signal being supplied as input to a DDS controlalgorithm implemented by the logic device 816.

In another form, for example, the current feedback data may be monitoredin order to maintain the current amplitude of the drive signal at acurrent amplitude setpoint. The current amplitude setpoint may bespecified directly or determined indirectly based on specified voltageamplitude and power setpoints. In certain forms, control of the currentamplitude may be implemented by control algorithm, such as, for example,a proportional-integral-derivative (PID) control algorithm, in the DSPprocessor 822. Variables controlled by the control algorithm to suitablycontrol the current amplitude of the drive signal may include, forexample, the scaling of the LUT waveform samples stored in the logicdevice 816 and/or the full-scale output voltage of the DAC circuit 818(which supplies the input to the power amplifier 812) via a DAC circuit834.

The non-isolated stage 804 may further comprise a second processor 836for providing, among other things user interface (UI) functionality. Inone form, the UI processor 836 may comprise an Atmel AT91SAM9263processor having an ARM 926EJ-S core, available from Atmel Corporation,San Jose, Calif., for example. Examples of UI functionality supported bythe UI processor 836 may include audible and visual user feedback,communication with peripheral devices (e.g., via a USB interface),communication with a foot switch, communication with an input device(e.g., a touch screen display) and communication with an output device(e.g., a speaker). The UI processor 836 may communicate with the DSPprocessor 822 and the logic device 816 (e.g., via SPI buses). Althoughthe UI processor 836 may primarily support UI functionality, it may alsocoordinate with the DSP processor 822 to implement hazard mitigation incertain forms. For example, the UI processor 836 may be programmed tomonitor various aspects of user input and/or other inputs (e.g., touchscreen inputs, foot switch inputs, temperature sensor inputs) and maydisable the drive output of the generator 800 when an erroneouscondition is detected.

In certain forms, both the DSP processor 822 and the UI processor 836,for example, may determine and monitor the operating state of thegenerator 800. For the DSP processor 822, the operating state of thegenerator 800 may dictate, for example, which control and/or diagnosticprocesses are implemented by the DSP processor 822. For the UI processor836, the operating state of the generator 800 may dictate, for example,which elements of a UI (e.g., display screens, sounds) are presented toa user. The respective DSP and UI processors 822, 836 may independentlymaintain the current operating state of the generator 800 and recognizeand evaluate possible transitions out of the current operating state.The DSP processor 822 may function as the master in this relationshipand determine when transitions between operating states are to occur.The UI processor 836 may be aware of valid transitions between operatingstates and may confirm if a particular transition is appropriate. Forexample, when the DSP processor 822 instructs the UI processor 836 totransition to a specific state, the UI processor 836 may verify thatrequested transition is valid. In the event that a requested transitionbetween states is determined to be invalid by the UI processor 836, theUI processor 836 may cause the generator 800 to enter a failure mode.

The non-isolated stage 804 may further comprise a controller 838 formonitoring input devices (e.g., a capacitive touch sensor used forturning the generator 800 on and off, a capacitive touch screen). Incertain forms, the controller 838 may comprise at least one processorand/or other controller device in communication with the UI processor836. In one form, for example, the controller 838 may comprise aprocessor (e.g., a Meg168 8-bit controller available from Atmel)configured to monitor user input provided via one or more capacitivetouch sensors. In one form, the controller 838 may comprise a touchscreen controller (e.g., a QT5480 touch screen controller available fromAtmel) to control and manage the acquisition of touch data from acapacitive touch screen.

In certain forms, when the generator 800 is in a “power off” state, thecontroller 838 may continue to receive operating power (e.g., via a linefrom a power supply of the generator 800, such as the power supply 854discussed below). In this way, the controller 838 may continue tomonitor an input device (e.g., a capacitive touch sensor located on afront panel of the generator 800) for turning the generator 800 on andoff. When the generator 800 is in the power off state, the controller838 may wake the power supply (e.g., enable operation of one or moreDC/DC voltage converters 856 of the power supply 854) if activation ofthe “on/off” input device by a user is detected. The controller 838 maytherefore initiate a sequence for transitioning the generator 800 to a“power on” state. Conversely, the controller 838 may initiate a sequencefor transitioning the generator 800 to the power off state if activationof the “on/off” input device is detected when the generator 800 is inthe power on state. In certain forms, for example, the controller 838may report activation of the “on/off” input device to the UI processor836, which in turn implements the necessary process sequence fortransitioning the generator 800 to the power off state. In such forms,the controller 838 may have no independent ability for causing theremoval of power from the generator 800 after its power on state hasbeen established.

In certain forms, the controller 838 may cause the generator 800 toprovide audible or other sensory feedback for alerting the user that apower on or power off sequence has been initiated. Such an alert may beprovided at the beginning of a power on or power off sequence and priorto the commencement of other processes associated with the sequence.

In certain forms, the isolated stage 802 may comprise an instrumentinterface circuit 840 to, for example, provide a communication interfacebetween a control circuit of a surgical instrument (e.g., a controlcircuit comprising handpiece switches) and components of thenon-isolated stage 804, such as, for example, the logic device 816, theDSP processor 822, and/or the UI processor 836. The instrument interfacecircuit 840 may exchange information with components of the non-isolatedstage 804 via a communication link that maintains a suitable degree ofelectrical isolation between the isolated and non-isolated stages 802,804, such as, for example, an IR-based communication link. Power may besupplied to the instrument interface circuit 840 using, for example, alow-dropout voltage regulator powered by an isolation transformer drivenfrom the non-isolated stage 804.

In one form, the instrument interface circuit 840 may comprise a logiccircuit 842 (e.g., logic circuit, programmable logic circuit, PGA, FPGA,PLD) in communication with a signal conditioning circuit 844. The signalconditioning circuit 844 may be configured to receive a periodic signalfrom the logic circuit 842 (e.g., a 2 kHz square wave) to generate abipolar interrogation signal having an identical frequency. Theinterrogation signal may be generated, for example, using a bipolarcurrent source fed by a differential amplifier. The interrogation signalmay be communicated to a surgical instrument control circuit (e.g., byusing a conductive pair in a cable that connects the generator 800 tothe surgical instrument) and monitored to determine a state orconfiguration of the control circuit. The control circuit may comprise anumber of switches, resistors, and/or diodes to modify one or morecharacteristics (e.g., amplitude, rectification) of the interrogationsignal such that a state or configuration of the control circuit isuniquely discernable based on the one or more characteristics. In oneform, for example, the signal conditioning circuit 844 may comprise anADC circuit for generating samples of a voltage signal appearing acrossinputs of the control circuit resulting from passage of interrogationsignal therethrough. The logic circuit 842 (or a component of thenon-isolated stage 804) may then determine the state or configuration ofthe control circuit based on the ADC circuit samples.

In one form, the instrument interface circuit 840 may comprise a firstdata circuit interface 846 to enable information exchange between thelogic circuit 842 (or other element of the instrument interface circuit840) and a first data circuit disposed in or otherwise associated with asurgical instrument. In certain forms, for example, a first data circuitmay be disposed in a cable integrally attached to a surgical instrumenthandpiece or in an adaptor for interfacing a specific surgicalinstrument type or model with the generator 800. The first data circuitmay be implemented in any suitable manner and may communicate with thegenerator according to any suitable protocol, including, for example, asdescribed herein with respect to the first data circuit. In certainforms, the first data circuit may comprise a non-volatile storagedevice, such as an EEPROM device. In certain forms, the first datacircuit interface 846 may be implemented separately from the logiccircuit 842 and comprise suitable circuitry (e.g., discrete logicdevices, a processor) to enable communication between the logic circuit842 and the first data circuit. In other forms, the first data circuitinterface 846 may be integral with the logic circuit 842.

In certain forms, the first data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information. This informationmay be read by the instrument interface circuit 840 (e.g., by the logiccircuit 842), transferred to a component of the non-isolated stage 804(e.g., to logic device 816, DSP processor 822, and/or UI processor 836)for presentation to a user via an output device and/or for controlling afunction or operation of the generator 800. Additionally, any type ofinformation may be communicated to the first data circuit for storagetherein via the first data circuit interface 846 (e.g., using the logiccircuit 842). Such information may comprise, for example, an updatednumber of operations in which the surgical instrument has been usedand/or dates and/or times of its usage.

As discussed previously, a surgical instrument may be detachable from ahandpiece (e.g., the multifunction surgical instrument may be detachablefrom the handpiece) to promote instrument interchangeability and/ordisposability. In such cases, conventional generators may be limited intheir ability to recognize particular instrument configurations beingused and to optimize control and diagnostic processes accordingly. Theaddition of readable data circuits to surgical instruments to addressthis issue is problematic from a compatibility standpoint, however. Forexample, designing a surgical instrument to remain backwardly compatiblewith generators that lack the requisite data reading functionality maybe impractical due to, for example, differing signal schemes, designcomplexity, and cost. Forms of instruments discussed herein addressthese concerns by using data circuits that may be implemented inexisting surgical instruments economically and with minimal designchanges to preserve compatibility of the surgical instruments withcurrent generator platforms.

Additionally, forms of the generator 800 may enable communication withinstrument-based data circuits. For example, the generator 800 may beconfigured to communicate with a second data circuit contained in aninstrument (e.g., the multifunction surgical instrument). In some forms,the second data circuit may be implemented in a many similar to that ofthe first data circuit described herein. The instrument interfacecircuit 840 may comprise a second data circuit interface 848 to enablethis communication. In one form, the second data circuit interface 848may comprise a tri-state digital interface, although other interfacesmay also be used. In certain forms, the second data circuit maygenerally be any circuit for transmitting and/or receiving data. In oneform, for example, the second data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information.

In some forms, the second data circuit may store information about theelectrical and/or ultrasonic properties of an associated ultrasonictransducer, end effector, or ultrasonic drive system. For example, thefirst data circuit may indicate a burn-in frequency slope, as describedherein. Additionally or alternatively, any type of information may becommunicated to second data circuit for storage therein via the seconddata circuit interface 848 (e.g., using the logic circuit 842). Suchinformation may comprise, for example, an updated number of operationsin which the instrument has been used and/or dates and/or times of itsusage. In certain forms, the second data circuit may transmit dataacquired by one or more sensors (e.g., an instrument-based temperaturesensor). In certain forms, the second data circuit may receive data fromthe generator 800 and provide an indication to a user (e.g., a lightemitting diode indication or other visible indication) based on thereceived data.

In certain forms, the second data circuit and the second data circuitinterface 848 may be configured such that communication between thelogic circuit 842 and the second data circuit can be effected withoutthe need to provide additional conductors for this purpose (e.g.,dedicated conductors of a cable connecting a handpiece to the generator800). In one form, for example, information may be communicated to andfrom the second data circuit using a one-wire bus communication schemeimplemented on existing cabling, such as one of the conductors usedtransmit interrogation signals from the signal conditioning circuit 844to a control circuit in a handpiece. In this way, design changes ormodifications to the surgical instrument that might otherwise benecessary are minimized or reduced. Moreover, because different types ofcommunications implemented over a common physical channel can befrequency-band separated, the presence of a second data circuit may be“invisible” to generators that do not have the requisite data readingfunctionality, thus enabling backward compatibility of the surgicalinstrument.

In certain forms, the isolated stage 802 may comprise at least oneblocking capacitor 850-1 connected to the drive signal output 810 b toprevent passage of DC current to a patient. A single blocking capacitormay be required to comply with medical regulations or standards, forexample. While failure in single-capacitor designs is relativelyuncommon, such failure may nonetheless have negative consequences. Inone form, a second blocking capacitor 850-2 may be provided in serieswith the blocking capacitor 850-1, with current leakage from a pointbetween the blocking capacitors 850-1, 850-2 being monitored by, forexample, an ADC circuit 852 for sampling a voltage induced by leakagecurrent. The samples may be received by the logic circuit 842, forexample. Based changes in the leakage current (as indicated by thevoltage samples), the generator 800 may determine when at least one ofthe blocking capacitors 850-1, 850-2 has failed, thus providing abenefit over single-capacitor designs having a single point of failure.

In certain forms, the non-isolated stage 804 may comprise a power supply854 for delivering DC power at a suitable voltage and current. The powersupply may comprise, for example, a 400 W power supply for delivering a48 VDC system voltage. The power supply 854 may further comprise one ormore DC/DC voltage converters 856 for receiving the output of the powersupply to generate DC outputs at the voltages and currents required bythe various components of the generator 800. As discussed above inconnection with the controller 838, one or more of the DC/DC voltageconverters 856 may receive an input from the controller 838 whenactivation of the “on/off” input device by a user is detected by thecontroller 838 to enable operation of, or wake, the DC/DC voltageconverters 856.

FIG. 21 illustrates an example of a generator 900, which is one form ofthe generator 800 (FIG. 21 ). The generator 900 is configured to delivermultiple energy modalities to a surgical instrument. The generator 900provides RF and ultrasonic signals for delivering energy to a surgicalinstrument either independently or simultaneously. The RF and ultrasonicsignals may be provided alone or in combination and may be providedsimultaneously. As noted above, at least one generator output candeliver multiple energy modalities (e.g., ultrasonic, bipolar ormonopolar RF, irreversible and/or reversible electroporation, and/ormicrowave energy, among others) through a single port, and these signalscan be delivered separately or simultaneously to the end effector totreat tissue.

The generator 900 comprises a processor 902 coupled to a waveformgenerator 904. The processor 902 and waveform generator 904 areconfigured to generate a variety of signal waveforms based oninformation stored in a memory coupled to the processor 902, not shownfor clarity of disclosure. The digital information associated with awaveform is provided to the waveform generator 904 which includes one ormore DAC circuits to convert the digital input into an analog output.The analog output is fed to an amplifier 1106 for signal conditioningand amplification. The conditioned and amplified output of the amplifier906 is coupled to a power transformer 908. The signals are coupledacross the power transformer 908 to the secondary side, which is in thepatient isolation side. A first signal of a first energy modality isprovided to the surgical instrument between the terminals labeledENERGY1 and RETURN. A second signal of a second energy modality iscoupled across a capacitor 910 and is provided to the surgicalinstrument between the terminals labeled ENERGY2 and RETURN. It will beappreciated that more than two energy modalities may be output and thusthe subscript “n” may be used to designate that up to n ENERGYnterminals may be provided, where n is a positive integer greater than 1.It also will be appreciated that up to “n” return paths RETURNn may beprovided without departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across the terminalslabeled ENERGY1 and the RETURN path to measure the output voltagetherebetween. A second voltage sensing circuit 924 is coupled across theterminals labeled ENERGY2 and the RETURN path to measure the outputvoltage therebetween. A current sensing circuit 914 is disposed inseries with the RETURN leg of the secondary side of the powertransformer 908 as shown to measure the output current for either energymodality. If different return paths are provided for each energymodality, then a separate current sensing circuit should be provided ineach return leg. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to respective isolation transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 918. The outputs of the isolationtransformers 916, 928, 922 in the on the primary side of the powertransformer 908 (non-patient isolated side) are provided to a one ormore ADC circuit 926. The digitized output of the ADC circuit 926 isprovided to the processor 902 for further processing and computation.The output voltages and output current feedback information can beemployed to adjust the output voltage and current provided to thesurgical instrument and to compute output impedance, among otherparameters. Input/output communications between the processor 902 andpatient isolated circuits is provided through an interface circuit 920.Sensors also may be in electrical communication with the processor 902by way of the interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 bydividing the output of either the first voltage sensing circuit 912coupled across the terminals labeled ENERGY1/RETURN or the secondvoltage sensing circuit 924 coupled across the terminals labeledENERGY2/RETURN by the output of the current sensing circuit 914 disposedin series with the RETURN leg of the secondary side of the powertransformer 908. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to separate isolations transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The digitized voltage and currentsensing measurements from the ADC circuit 926 are provided the processor902 for computing impedance. As an example, the first energy modalityENERGY1 may be ultrasonic energy and the second energy modality ENERGY2may be RF energy. Nevertheless, in addition to ultrasonic and bipolar ormonopolar RF energy modalities, other energy modalities includeirreversible and/or reversible electroporation and/or microwave energy,among others. Also, although the example illustrated in FIG. 21 shows asingle return path RETURN may be provided for two or more energymodalities, in other aspects, multiple return paths RETURNn may beprovided for each energy modality ENERGYn. Thus, as described herein,the ultrasonic transducer impedance may be measured by dividing theoutput of the first voltage sensing circuit 912 by the current sensingcircuit 914 and the tissue impedance may be measured by dividing theoutput of the second voltage sensing circuit 924 by the current sensingcircuit 914.

As shown in FIG. 21 , the generator 900 comprising at least one outputport can include a power transformer 908 with a single output and withmultiple taps to provide power in the form of one or more energymodalities, such as ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers, for example, to the end effector depending on the type oftreatment of tissue being performed. For example, the generator 900 candeliver energy with higher voltage and lower current to drive anultrasonic transducer, with lower voltage and higher current to drive RFelectrodes for sealing tissue, or with a coagulation waveform for spotcoagulation using either monopolar or bipolar RF electrosurgicalelectrodes. The output waveform from the generator 900 can be steered,switched, or filtered to provide the frequency to the end effector ofthe surgical instrument. The connection of an ultrasonic transducer tothe generator 900 output would be preferably located between the outputlabeled ENERGY1 and RETURN as shown in FIG. 21 . In one example, aconnection of RF bipolar electrodes to the generator 900 output would bepreferably located between the output labeled ENERGY2 and RETURN. In thecase of monopolar output, the preferred connections would be activeelectrode (e.g., pencil or other probe) to the ENERGY2 output and asuitable return pad connected to the RETURN output.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is hereinincorporated by reference in its entirety.

Robotic surgical systems can be used in minimally invasive medicalprocedures. During such medical procedures, a patient can be placed on aplatform adjacent to a robotic surgical system, and a surgeon can bepositioned at a console that is remote from the platform and/or from therobot. For example, the surgeon can be positioned outside the sterilefield that surrounds the surgical site. The surgeon provides input to auser interface via an input device at the console to manipulate asurgical tool coupled to an arm of the robotic system. The input devicecan be a mechanical input devices such as control handles or joysticks,for example, or contactless input devices such as optical gesturesensors, for example.

The robotic surgical system can include a robot tower supporting one ormore robotic arms. At least one surgical tool (e.g. an end effectorand/or endoscope) can be mounted to the robotic arm. The surgicaltool(s) can be configured to articulate relative to the respectiverobotic arm via an articulating wrist assembly and/or to translaterelative to the robotic arm via a linear slide mechanism, for example.During the surgical procedure, the surgical tool can be inserted into asmall incision in a patient via a cannula or trocar, for example, orinto a natural orifice of the patient to position the distal end of thesurgical tool at the surgical site within the body of the patient.Additionally or alternatively, the robotic surgical system can beemployed in an open surgical procedure in certain instances.

A schematic of a robotic surgical system 15000 is depicted in FIG. 22 .The robotic surgical system 15000 includes a central control unit 15002,a surgeon's console 15012, a robot 15022 including one or more roboticarms 15024, and a primary display 15040 operably coupled to the controlunit 15002. The surgeon's console 15012 includes a display 15014 and atleast one manual input device 15016 (e.g., switches, buttons, touchscreens, joysticks, gimbals, etc.) that allow the surgeon totelemanipulate the robotic arms 15024 of the robot 15022. The readerwill appreciate that additional and alternative input devices can beemployed.

The central control unit 15002 includes a processor 15004 operablycoupled to a memory 15006. The processor 15004 includes a plurality ofinputs and outputs for interfacing with the components of the roboticsurgical system 15000. The processor 15004 can be configured to receiveinput signals and/or generate output signals to control one or more ofthe various components (e.g., one or more motors, sensors, and/ordisplays) of the robotic surgical system 15000. The output signals caninclude, and/or can be based upon, algorithmic instructions which may bepre-programmed and/or input by the surgeon or another clinician. Theprocessor 15004 can be configured to accept a plurality of inputs from auser, such as the surgeon at the console 15012, and/or may interfacewith a remote system. The memory 15006 can be directly and/or indirectlycoupled to the processor 15004 to store instructions and/or databases.

The robot 15022 includes one or more robotic arms 15024. Each roboticarm 15024 includes one or more motors 15026 and each motor 15026 iscoupled to one or more motor drivers 15028. For example, the motors15026, which can be assigned to different drivers and/or mechanisms, canbe housed in a carriage assembly or housing. In certain instances, atransmission intermediate a motor 15026 and one or more drivers 15028can permit coupling and decoupling of the motor 15026 to one or moredrivers 15028. The drivers 15028 can be configured to implement one ormore surgical functions. For example, one or more drivers 15028 can betasked with moving a robotic arm 15024 by rotating the robotic arm 15024and/or a linkage and/or joint thereof. Additionally, one or more drivers15028 can be coupled to a surgical tool 15030 and can implementarticulating, rotating, clamping, sealing, stapling, energizing, firing,cutting, and/or opening, for example. In certain instances, the surgicaltools 15030 can be interchangeable and/or replaceable. Examples ofrobotic surgical systems and surgical tools are further describedherein.

The reader will readily appreciate that the computer-implementedinteractive surgical system 100 (FIG. 1 ) and the computer-implementedinteractive surgical system 200 (FIG. 9 ) can incorporate the roboticsurgical system 15000. Additionally or alternatively, the roboticsurgical system 15000 can include various features and/or components ofthe computer-implemented interactive surgical systems 100 and 200.

In one exemplification, the robotic surgical system 15000 can encompassthe robotic system 110 (FIG. 2 ), which includes the surgeon's console118, the surgical robot 120, and the robotic hub 122. Additionally oralternatively, the robotic surgical system 15000 can communicate withanother hub, such as the surgical hub 106, for example. In one instance,the robotic surgical system 15000 can be incorporated into a surgicalsystem, such as the computer-implemented interactive surgical system 100(FIG. 1 ) or the computer-implemented interactive surgical system 200(FIG. 9 ), for example. In such instances, the robotic surgical system15000 may interact with the cloud 104 or the cloud 204, respectively,and the surgical hub 106 or the surgical hub 206, respectively. Incertain instances, a robotic hub or a surgical hub can include thecentral control unit 15002 and/or the central control unit 15002 cancommunicate with a cloud. In other instances, a surgical hub can embodya discrete unit that is separate from the central control unit 15002 andwhich can communicate with the central control unit 15002.

Robotic Arm Kinematics and Control System

As discussed above, robotic control systems of the present disclosuredescribed herein such as robotic surgical system 13000 of FIG. 4 mayinclude robotic arms such as robotic arms 13002, 13003. The robotic armscan be capable of performing various kinematic functions. One example ofsuch kinematic functions is linear slide kinematics. In FIG. 23 , asurgical robotic arm 20002 which is similar to robotic arms 13002, 13003is depicted. As discussed above, the robotic arm 20002 is configured toreleasably secure a robotic surgical assembly such as surgical assembly13010 or others described herein. The robotic arm 20002 may also beconfigured to secure and/or control surgical instruments describedherein such as surgical instrument 13020 or end effectors describedherein such as end effector 13023. In FIG. 23 , the robotic arm 20002controls surgical instrument 20200, which could be part of the roboticsurgical assembly 13010, for example. The robotic arm 20002 can bedriven by electric drives (not shown) that are connected to a controldevice which may be similar to the common control module 610 of FIG. 16, for example. The control device could be communicatively coupled to acontrol circuit of the surgical instrument 20200, such as controlcircuit 710 of FIG. 17 , for example. As shown in FIG. 23 , a surgicalinstrument holder can include a housing 20106 and a carriage 20104. Thesurgical instrument holder may slide along a rail 20040 of the roboticarm 20002. In this way, the surgical instrument holder can implement thelinear slide kinematics of the robotic arm 20002. For example, when themotor (which could be similar in operation to a motor of the surgicalinstrument 20200 such as motor 754) that is coupled to the robotic arm20002 is actuated, the surgical instrument 20200 can be linearly movedalong the robotic arm 20002 towards a desired location such as treatmentarea of a patient.

The motor may also be used to cause the robotic arm to move in a lineardirection or movement. The surgical instrument 20200 can also be rotatedby the robotic arm 20002 based on transferring power from the motor. Tothis end, an instrument drive unit 20400 can transfer power andactuation forces from the motor to a drive assembly of an adapterassembly to drive a rotation of surgical instrument 20200 (such as anendoscope) up to least about 180 degrees about its longitudinal axis.The carriage 20104 may be configured to non-rotatably support an outershell 20402. Further details about the surgical assembly depicted inFIG. 23 may be found in U.S. Patent Publication 2018/0153634, which ishereby incorporated by reference.

The robotic arm 20002 can also releasably control surgical instrumentsrelative to a trocar placed relative to a surgical site. FIG. 24illustrates a side view of the robotic arm 20002, including a mountingassembly 20210 for securing surgical tools thereto. The robotic arm20002 can be constructed of three members connected via joints, as shownin FIG. 24 . The mounting assembly 20210 is coupled to a distal end ofthe arm 20002 and includes a mounting device 20230 and alongitudinally-extending support 20240. The mounting device 20230 maysupport a clamping and release assembly 20234. The mounting device 20230is also configured to selectively secure a variety of surgicalinstruments or tools therein to thereby secure a surgical tool to therobotic arm 20002. The mounting device 20230 also may be designed toreceive a trocar 20250. The trocar 20250 is releasably secured withinthe mounting device 20230 through a transition between an openconfiguration and a closed configuration of the clamping assembly 20234.The trocar 20250 can include a cannula 20252 configured to provide apathway to a surgical site within the patient and has an access port20254 for receiving an end effector of the surgical instrument 20200,which may be similar to end effectors (e.g., end effector 13023)described herein to perform the surgical operation on the patient. Theend effector could include a jaw assembly 20266.

The longitudinally-extending support 20240 can support a vertical rail20040. The vertical rail 20040 is coupled to the support 20240 andextends along a length of the support 20240. The vertical rail 20040 isconfigured such that the surgical instrument 20200 may be slideablycoupled thereto and aligned with the trocar 20250. In particular, thejaw assembly 20266 extending from a shaft 20262 (which may be similar toshafts described herein such as shaft 740) of the instrument 20200 issubstantially aligned with the trocar 20250 so that it can be insertedinto or removed from the access port 20254 of the trocar 20250. Thevertical rail 20040 can be configured for positioning the jaw assembly20266 of the surgical instrument 20200 at least between a position P1located just prior to entry into the access port 20254 and a position P2located a distance from the access port 20254. Further details about thesurgical assembly depicted in FIG. 24 may be found in U.S. PatentPublication 2017/044406, which is hereby incorporated by referenceherein in its entirety.

As shown in FIG. 25 , the robotic arm 20002 can also be configured toimplement robotic spherical kinematics of a robotic surgical assembly20030 releasably secured by the robotic arm 20002. That is, robotic arm20002 can be connected to the control device, which may control aplurality of motors, with each motor configured to drive movement of therobotic arm 20002 in a plurality of directions. The plurality of motorscan form a motor pack. These directions including rotational as well aslinear direction. Also, the motors could be connected to more than onerobotic arm 20002, such as the two robotic arms 13002, 13003 of FIG. 4 ,for example. The control device may control the motor pack of aninstrument drive unit (IDU) to drive various operations of surgicalinstrument 20200, and may control a rotation of the motor pack toultimately rotate surgical instrument 20200 along a longitudinal axis ofthe IDU. Each motor of the motor pack can be configured to actuate adrive rod or a lever arm to effect operation and/or movement of each endeffector (not shown) of the surgical instrument(s) 20200. The motors canbe supported by the carriage 20104, which is slidably mounted on therail 20040. The carriage 20104 may be part of an IDU holder 20102. FIG.26 shows the robotic arm 20002 supporting a mounting structure 20500with spherical robotic kinematic capabilities. The mounting structure20500 could be removably or fixedly coupled to robot arm 20002.Furthermore, a portion (e.g., a proximal housing 20510) of mountingstructure 20500 may be rotatable with respect to another portion (e.g.,a distal housing 20520) of mounting structure 20500, such that at leasta portion of the mounting structure 20500 is rotatable with respect torobot arm 20002. The mounting structure 20500 can be configured toaccept a cannula assembly at least partially therein. In general, therobotic arm 20002 could support multiple types of components usable withsurgical or medical procedures, in which these components are rotatablymovable based on the associated motor(s). Further details about thesurgical assembly depicted in FIGS. 25 and 26 may be found in WorldIntellectual Patent Organization Patent Publication WO 2017/205576 andWorld Intellectual Patent Organization Patent Publication WO2017/205467, each of which is hereby incorporated by reference herein inits entirety.

The motors of the motor pack housed within the IDU can be configured topower the surgical instrument 20200 to drive various operations of theattached end effector (e.g., jaw assembly 20266). The jaw assembly 20266could include a staple cartridge, knife blade or other suitable tissueeffecting components such as fastening, cutting, clamping elements fordriving one or more of the various operations. The jaw assembly 20266could be directly coupled to an instrument drive connector (which can becoupled to the IDU) or alternatively to a surgical loading unit of therobotic surgical assembly 20030. The IDU can be supported or connectedto a slider that is movably connected to a track (e.g., vertical rail20040) of the robotic arm 20002. In this way, the slide may move, slide,or translate along a longitudinal axis defined by the track of therobotic arm 20002 upon a selective actuation by motors. Thus, the slidercan move to selected locations along the track and provide positionalfeedback to the clinician. Further details can be found in U.S. PatentPublication U.S. 2018/0250080, which is hereby incorporated by referenceherein in its entirety.

In some aspects, the robotic surgical assembly 20030 including roboticarm 20002 and a motor pack comprising multiple motors each configured toactuate a lever arm of the robotic surgical assembly 20030 could beconsidered an underactuated system. In other words, the number of leverarm or actuators of the robotic surgical assembly 20030 could be lessthan the number of degrees of freedom such that there are fewer motoractuators than the number of joints in the robotic surgical assembly20030. The robotic surgical assembly 20030 could be considered to haveat least two joints, for example, but there might be only one motoractuator. In such situations, the control device could be programmed tocontrol coupled joint motion of a multi-bar linkage system. The linkagescan be understood as part of particular robotic arms, such as therobotic arm 20002 having n number of linkages, for example. Inparticular, the control device could control the sum of linked joints tokeep the location or pivot of the trocar 20250 in the same locationwhile the several linked joints of the robotic surgical assembly 20030simultaneously move together. The multi-bar linkage system could besubdivided into different operative sections. For example, some sectionsof the robot control arm(s) 20002 could be linked and cooperativelymoved by the control device while the control device also maintainsanother set of linked joints that can be held or moved autonomously tothe first set. In one aspect, one control device could control a firstset of linked joints while another control device could control a secondset of linked joints.

Multiple different types of multi-bar linkage system are contemplated,including four-bar linkages. Such four-bar linkages could enablecontinuous motion, such as parallelogram linkage, drag-link, andcrank-rocket linkages, or they could be characterized as having nocontinuous motion, such as double-rocker linkages. The parallelogramlinkage may be characterized by equal length paired linkage legs coupledin a manner in which the motion of one set is mirrored by the other setto establish paired motion with constant end-points. The drag-link maybe characterized by the presence of one or more primary links. In thedrag-link, a first spherical rotation of a primary link could result ina second spherical rotation of a second primary link at a rate that isproportionate to the differences in length of the two primary links(i.e., first and second primary link). The crank-rocker can becharacterized by a full circular sweep of a first shorter primary linkthat results in a limited arc of a larger radius than the follower pathof the second primary link. The double-rocker can be characterized by aconnection link that is significantly shorter than the link between theend-points. Accordingly, for the double-rocker, this results in twoarcuate paths for the two primary link motions that only work within alimited angle of operation.

Multiple control methodologies by the control device to control therobotic surgical assembly 20030 including the robotic arm 20002 are alsocontemplated, including forward kinematics, inverse kinematics, Jacobiantranspose, and teleoperation as well as force controlled actuation.Forward kinematics may include Jacobian coordinates to representelliptic curve points, since the robotic arm 20002 can be capable ofspherical kinematic capabilities. Using position sensors that can besimilar in operation to position sensor 472 of FIG. 12 , for example,the control device may determine the end point position of the roboticarm 20002 such as relative to the trocar 20250. With forward kinematicsobtained by the control device using the integration of a kinematicmodel, the control device can solve for the pose (position andorientation) of the robotic arm 20002. This way, the control device maydetermine the endpoint and joint position or derivatives thereof of therobotic surgical assembly 20030 including the robotic arm 20002 in bothsituations where the robotic arm 20002 continues forward movement in itscurrent direction or rotates. The forward kinematics could also beapproached from an opposing perspective. Using inverse kinematics, thecontrol device can solve for the robotic joint velocities necessary fora particular desired end effector (e.g., end effector 13023) velocity.In other words, the control device may control the joint of the roboticsurgical assembly 20030 to determine the joint positions required for aparticular endpoint placement and orientation (pose) corresponding to adesired pose of the end effector of the surgical instrument 20200 orsurgical tool securably controlled by the robotic surgical assembly20030.

The Jacobian transpose is a control methodology to control the roboticsurgical assembly 20030 and robotic arm 20002 in a specific task space.In particular, the Jacobian transpose may relate the pose of the securedend effector to a corresponding set of joint angles; that is, howmovement of the joint angles causes movement of the end effector. Thisway, the control device can determine the applicable force-torquerequirements and control the torque applied by the motor actuators/packto the set of joint angles based on the respective workspace coordinatesand end effector force constraints. The control device may also useteleoperation to remotely control and operate the end effector securablyheld by the robotic arm 20002. Teleoperation may involve a master-slavetype relationship in which the master controller controls motion of theslave end effector. The master controller can be used by a clinician, inwhich the master controller may be joystick controller, virtual realitycontroller, some controller similar to manual input devices 13007,13008, or some other suitable controller. The master controller mightconstitute a unilateral control model in which motion as indicated byuser control signals input into the master controller for example, aretranslated to the robotic end effector. Thus, although there could be adisplay device such as display device 13006 to display images of thesurgical site, the joystick controls of the master controller may notcomprise any feedback. Alternatively, the master controller mightconstitute a bilateral control model with haptic or force based feedbackcontrol, for example. Thus, any force or interactions made for themaster controller or slave end effector are reflected in the control andoperation of the other. Moreover, when the motions of the mastercontroller are reflected in the end effector, the location of the endeffector can be proportionate to the motions input into the mastercontroller. Accordingly, when the master controller's position isrecorded, the slave end effector or slave robot may follow the mastercontroller's position in a corresponding fashion.

The control device could also implement a force controlled actuationcontrol methodology. In such a methodology, the motor(s) associated withthe robotic arm 20002 can be directly controlled by the control deviceto directly incorporate force and motion into control of the robotic arm20002 and the robotic surgical assembly 20030. The force and motioncomponents of the robotic control could be performed in isolation orsimultaneously. In a hybrid force and position control approach, thecontrol device could operate in six axes, such as a three x-, y-, andz-direction axes for force and three x-, y-, and z-directions fortorque. With the six axes, the control device may separately apply amotion based control or a force based control onto each of the axes.That is, the control device could send control signals in each axis tothe motor pack for this purpose. In a parallel force and positioncontrol approach, the control device could implement motion basedcontrol and force based control simultaneously. Alternatively, thecontrol device may implement indirect force control in which forceconstraints, admittance control, or impedance control, for example,could be used to indirectly control motion. For example, the forceconstraints could be applied by the control device when position of therobotic arm 20002 deviates from the target position beyond a deviationthreshold. These constraints can be different from a closed forcefeedback loop. The impedance control could comprise the control deviceimplementing a maximum biasing response force, so that applied force tothe robotic arm 20002 could be modified depending how much progress isbeing made in the motion of the robotic arm 20002. Admittance controlcan refer to the control device implementing a relationship between theamount of applied force and motion; for example, the more force isapplied, the greater the amount of position change that is caused.Accordingly, a force sensor such as one similar in operation to forcesensor 788 of FIG. 19 may be used to measure the extent of an appliedinput force so that the robotic arm 20002 can be controlled by thecontrol device to move proportionally to the applied input force.

As shown in FIG. 27 , a system architecture 20100 for the roboticsurgical system 13000 to implement this force controlled actuation isdepicted. The system architecture 20100 comprises a core module 20120, asurgeon master module 20130, a robot arm module 20140, and an instrumentmodule 20150. The core module 20120 may serve as a central controllerfor the robotic surgical system 13000 and coordinate operations of allof the other modules 20130, 20140, 20150. For example, there could bemore than one robotic arm 20002, and the core module 20120 could mapcontrol devices to each of the robotic arms, determine current status,perform all kinematics and frame transformations, and relay resultingmovement commands. In this regard, the core module 20120 may receive andanalyze data from each of the other modules 20130, 20140, 20150 in orderto provide instructions or commands to the other modules 20130, 20140,20150 for execution within the robotic surgical system 13000. Therelayed movement commands may be based on a measured extent of theapplied input force, as discussed above. This way, the core module 20120can specifically control a robotic arm such as robotic arm 20002 toapply a controlled force to an object.

The controlled force could be tailored for specific operations such asdeburring, grinding, pushing an object, or some other suitableoperation. Although depicted as separate modules, one or more of themodules 20130, 20140, and 20150 are a single component in other aspects.The core module 20120 includes models 20122, observers 20124, acollision manager 20126, controllers 20128, and a skeleton 20129. Themodels 20122 may include units that provide abstracted representations(base classes) for controlled components, such as the motors of themotor pack and/or the arm(s) 20002. The observers 20124 create stateestimates based on input and output signals received from the othermodules 20130, 20140, 20150. The collision manager 20126 can preventcollisions between components that have been registered within thesystem 13000. The skeleton 20129 may track the system 13000 from akinematic and dynamics point of view, including forward, inversekinematics etc. as discussed above. The dynamics item may be implementedas algorithms used to model dynamics of the components of the system13000. This tracking and modeling can be used to address the geometricuncertainty involved with controlling the robotic surgical assembly20030. Aside from monitoring the robotic surgical assembly 20030, thecollision manager 20126 and skeleton 20129 could monitor the appliedforce and corresponding movement of various components within the system13000 to avoid high or excessive forces applied to the surgicalenvironment, which may improve safety of the system 13000. The surgeonmaster module 20130 may communicates with clinician control devices(e.g., master controller) and relays inputs received from these devicesto the core module 20120.

In one aspect, the surgeon master module 20130 communicates buttonstatus and control device positions to the core module 20120 andincludes a node controller 20132. The robot arm module 20140 maycoordinate operation of a robot arm subsystem including robotic arms(e.g., robotic arm 20002), an arm cart subsystem, a set up arm, and aninstrument subsystem in order to control movement of the correspondingrobotic arms. Each robot arm module 20140 may correspond to and controla single arm. As such, additional robot arm modules 20140 are includedin configurations in which the system 13000 includes multiple armsrather than only the robotic arm 20002. The instrument module 20150controls movement of the surgical instrument 20200 attached to therobotic arm 20002. The instrument module 20150 may be configured tocorrespond to and control the single surgical instrument 20200.Accordingly, in aspects in which more than one surgical instrument areincluded, additional instrument modules 20150 may likewise be included.The instrument module 20150 can obtain and communicate data related tothe position of the end effector of the surgical instrument 20200 (whichmay include the pitch and yaw angle of the end effector jaws), the widthof or the angle between the jaws, and the position of an associatedaccess port.

Each of the node controllers 20132, 20142, 20152 comprises a state/modemanager, a fail-over controller, and a N degree of freedom (“DOF”)actuator, respectively. The position data collected by the instrumentmodule 20150 can be used by the core module 20120 to determine when theinstrument 20200 is within the surgical site (e.g., within an associatedcannula, adjacent to the access port, or above the access port in freespace). The core module 20120 may determine whether to provideinstructions to open or close the jaws of the surgical instrument 20200based on the positioning of the instrument 20200. For example, when theposition of the instrument 20200 indicates that the instrument 20200 iswithin the cannula, instructions may be provided to maintain the endeffector in a closed position. When the position of the instrument 20200indicates that the instrument 20200 outside of the access port,instructions may be provided to open the closed end effector. Based onthis position data and corresponding force applied to the robotic arm20002 or other movable component of the robotic surgical assembly 20030,the surgeon master module 20130 could provide improved force feedback toclinician users in bilateral teleoperation. Further details about thesurgical assembly depicted in FIG. 27 may be found in U.S. PatentPublication 2018/0153634, which is hereby incorporated by referenceherein it its entirety.

The motors of the motor pack could involve different types of motordrive mechanisms. For example, the motors could be local to the roboticarm 20002. As illustrated in FIG. 28 , the instrument drive unit (IDU)20400 has an adapter portion to extend through the mount 20005. Theadapter portion may have an engaging surface to operatively engage aportion of the surgical instrument 20200. Thus, the motor pack of theIDU 20400 is local to the robotic arm 20002 in FIG. 28 . FIG. 29 showsthat the robotic arm 20002 supports a rotatable torque sensor 20404 anda motor assembly 20406 that are coupled together by a drive belt 20412,in which the rotatable torque sensor 20404 and motor assembly 20406 maybe operationally connected to the IDU 20400. The torque sensor 20404 cansupport various electrical components (e.g., resistors, wires, etc.)configured to communicate with the control device associated with therobotic arm 20002 to provide torque feedback data, for example. Thetorque sensor 20404 could be coupled to the mount 20005, which could bean arm mount 20005 to secure the torque sensor 20404. Additionally, thetorque sensor 20404 may comprise a body defining a plurality of exposedgauges in which the body supports the various electrical components forcommunicating with the control device. The motor assembly 20406 includesat least one motor 20408 and a harmonic gear box 20410 that cooperate toimpart rotation on torque sensor 20404 via drive belt 20412 to effectrotation of the IDU 20400. This rotation may involve rotating the armmount 20005 about a transverse axis that is transverse relative to therobotic surgical assembly 20030.

In some aspects, the motor(s) 20408 of the motor assembly 20406 can beorganized as a motor pack of the IDU 20400. The locally positionedmotors 20408 can be arranged in a redundant coupling configurationbetween various joints of the robotic surgical assembly 20030 so thatmotion of the robotic arms could be synchronized. Alternatively, themotors 20408 could be controlled via a central location such as a hubcontrol device to control each IDU 20400 and motor pack of each roboticarm. Accordingly, in one aspect, the motors 20408 of the motor pack canbe centralized to a central location of the robotic surgical assembly20030 in which various linkages and/or cables are used to interconnectto the various arm joints of the multiple robotic arms of the roboticsurgical assembly 20030. Furthermore, the end effectors secured by eachof the multiple robotic arms could be steerable. For example, asteerable portion of a hollow tubular structured end effector may bemanipulated by the robotic arm 20002 relative to the trocar 20250. Inparticular, the cannula 20252 could be an active cannula 20252 capableof steering motions that can be adjusted depending on the progress ofthe surgical operation being performed on the patient. In one aspect,the steering mechanism could be a tendon-driven mechanism, which cancomprise an elastic central backbone and a group of tendons arranged inparallel about this back. This tendon-drive mechanism may have a conciseprofile that is easy to control. The steering mechanism of the endeffector can be remotely operated by the clinician. Further detailsregarding the motor drive mechanisms described herein may be found inWorld Intellectual Patent Organization Patent Publication WO2016/043845, which is hereby incorporated by reference herein in itsentirety.

In various aspects, the robotic surgical system 13000 can be used withan abdomen wall access port, which can be a type of the access port20254 described above. There may be a virtual port pivot, around whichvarious robotic arms such as the robotic arm 20002 can move. Thekinematics about the virtual port pivot can be used as part of insertionof the surgical instrument 20200 secured by the robotic arm 20002 intothe access port 20254 of the patient. Also, the robotic arm 20002 maycomprise a surgical mounting device configured to releasably secure anaccess device therein, including the trocar 20250, cannula 20252, accessport 20254 and other suitable access tools or instruments. The roboticarm 20002 can then pivot about the access device. The surgical mountingdevice might support a clamping assembly and a release mechanism, orrelease mechanisms. The surgical mounting device may be mechanicallyattached to the robotic arm 20002. Further details about this mountingdevice can be found in U.S. Patent Publication 2018/0177557, which ishereby incorporated by reference herein in its entirety. The rotation ofthe robotic arm 20002 may be rotation about a point that is notphysically located at, or is remote to the robotic surgical assembly20030. Restricted rotation about this remote point may be termed aremote center-of-motion (RCM) mechanism. Remote RCM mechanisms mayinclude parallel RCM, spherical RCM, and hybrid RCM. FIG. 30 illustratesa parallel RCM system in which the remote RCM robotic surgical system13000 comprises a base unit and multiple linking units coupled to eachother. At least two of the linking units are kept parallel to eachanother during motion. In various aspects, a robotic module is providedthat can be used to orient an end effector about two axes intersectingat a fixed geometric point located distal to the mechanism materializinga pivot point or a RCM. A robotic end effector mounted on a RCM modulewill rotate about the RCM point, which can be conveniently located onthe end effector since this point is remote from the robotic module.

In FIGS. 30A-30C, the module or mechanism 20160 may include first,second and third arms (also referred to as links and linking units) andwhich may be similar in operation to all or a subset of the robotic arm20002. One of the arms, such as the third arm could be configured toreceive a holder/driver that holds an end effector 20163 (e.g., could besimilar in operation to end effector 13023), depending on the applicabledesired functionality. The RCM module 20160 is configured to allow twoactive parallel degree-of-freedom (DOF) RCM mechanisms: a) rotation αabout axis x_(γ) of the base shaft 20161 representing a first pivotingaxis; and b) rotation β about axis y of the parallelogram structureformed by the second and third arms, and the end effector 20163,representing a second pivoting axis y. The two axes intersect at thecenter of the xyz coordinate system, representing the pivot point or RCMpoint of the mechanism. The RCM module 20160 is configured so that theadjustment angle γ between the elements 20169 and 20170 can be adjusted,and the elements 20169 and 20170 can be locked in a desired relativeorientation. The adjustment angle γ changes the orientation of the axisx_(γ) and shifts the location of the RCM point along the second pivotaxis y. This angular adjustment design may allow for convenientlysetting the pivot point to accommodate different end effectors (e.g.,end effector 20163) while maintaining a compact design. The RCM module20160 may have a folded configuration in which β₀=0°. This foldedoperation mode may allow the module 20160 not just to clear the RCMpivot, but also to clear the region above the RCM. This is important inperforming image-guided procedures, wherein the robotic surgicalassembly 20030 should be distal from the active field of the image toallow unimpeded visualization of the target end effector 20163 duringthe procedure. Conversely, the RCM module 20160 may also have a foldedconfiguration in which β₀=90°. In general, the module can operate abouta folded (β=0°), normal (β=90°), inverted (β=−90°), extended (β=180°),or any unfolded position (β{−90°, 0°, 90°, 180° }), with end effector20163 mounting on either side of the mechanism. Further details aboutparallel RCM mechanisms can be found in U.S. Patent Publication2018/0177557, which is hereby incorporated by reference in its entirety.

Spherical RCM may involve a circular-guiding arc RCM mechanism, forexample. As discussed above, RCM can be used to mechanically constrainthe position of a certain point in the surgical operation space. Aspherical RCM mechanism could involve more than 2 DOFs such as 3 DOF andcould be placed inside or outside the patient's body. Circular-guidingarcs, semi-circular arches, or other spherical-based linkages can beused as part of spherical RCM to model the robotic kinematics involvedin the insertion of surgical tools into an access or insertion port ofthe patient for surgery. Hybrid RCM mechanisms could enable 6 DOFsurgical tool motion. For example, the robotic kinematic could includefour segments: two parallel coupled joint elements, one prismatic andone optional revolute joint in the end effector 13023 to enable the 6DOF motion. The robotic surgical system 13000 can implement any of theRCM mechanisms described above or some other suitable RCM mechanism. Tothis end, the robotic surgical system 13000 could implement aninstantaneous and/or adjustable remote center of motion (ARCM)mechanism. That is, the fixed point in space (i.e., remote center ofmotion) about which the surgical instrument 20200 secured by the roboticsurgical assembly 20030 can be adjusted or changed. An adjustment of theremote center of rotation (RCM) O in an X-direction can be achieved bysimultaneous and equivalent movement in the prismatic joint 20034 andthe prismatic joint 20038.

The RCM can be adjusted from O to O′ by adjusting the position of thebelt clamp 20037 and/or YZ table 20020, for example. The surgicalinstrument 20200 is held by instrument holder 20006 and supported by theCM mechanism on one side of the revolute joint 20023. When the RCM isshifted to O′, the YZ table 20020 connected to the other side of therevolute joint 20023 also makes the adjustment of its respective Y and Zdirections. The prismatic joint 20034 and prismatic joint 20038 movetogether while the prismatic joint 20045 stays static to perform the RCMadjustment in the X-direction. When the adjustment is completed, RCM isenabled when the prismatic joint 20038 is fixed. The orientation of thesurgical instrument may be steered by the revolute joint 20023 to obtainits rotation around X-axis. The displacements of the joints 20046,20056, which are identical to the motion on the prismatic joint 20034and 20045 while the prismatic joint 20038 keeps static, can enable thesurgical instrument 20200 to rotate around Y-axis. Further details aboutARCM mechanisms can be found in U.S. Patent Publication 2012/0132018,which is hereby incorporated by reference herein in its entirety.

Moreover, RCM mechanics can be used with the robotic surgical system13000 to provide rotation around the incision point into the patient toprevent potential damage of the patient's tissue being treated by therobot surgical assembly 20030. Also for prevention of damage to thepatient, force feedback from the robotic arm 20002 can be provided tothe control device to mitigate accident involving the interactingrobotic arm(s) 20002. As discussed above, one or more control devicescould be provided. The control device may control a plurality of motors(e.g., of a motor pack), each of which is configured to actuate thesurgical instrument 20200 to effect operation and/or movement ofsurgical instrument 20200. Specifically, the control device maycoordinate the activation of the various motors to coordinate aclockwise or counter-clockwise rotation of drive members to coordinateoperation and/or movement of the surgical instrument 20200. As depictedin FIG. 32 , the robotic arm 20002 may include a plurality of movablelinks including a first link 20184, a second link 20186, a third link20188, and a holder such as instrument holder 20006, which are coupledto each other by actuators allowing for movement of the robotic arm20002 into various configurations. The links 20184, 20186, 20188 can berotatable about respective joints. The first link 20184 can comprise acurved base 20185 configured to secure the robotic arm 20002 to amovable base. Movement can occur via actuation forces transferred fromthe motors via the IDU, as discussed above.

Since the edges of the movable links of the robotic arm 20002, namely,the first and second links 20184 and 20186, the second and third links20186 and 20188, etc., are capable of being flush with each other, thereis a possibility of trapping and crushing various obstructions, such asuser's appendages, fingers, etc., between the links 20184, 20186, 20188as well as the holder. To address and mitigate such accidents, a sensorsystem may be provided to detect physical contact between the movablelinks of the robotic arm 20002 and to control the robotic arm 20002. Therobotic arm 20002 may include one or more sensor assemblies 20180disposed on any of the links or holder. The sensor assemblies 20180could be similar in operation to one or more of the sensors describedabove, such as the sensors 738. The sensor assemblies 20180 may bedisposed on any surface that present a high risk of crushing, shearing,or otherwise injuring body parts that may be caught by the robotic arm20002 during its movement. In some aspects, the sensor assemblies 20180may be disposed adjacent an inner edge (e.g., an edge that is closest toa neighboring link), or outer edge of the links 20184, 20186, 20188. Asensor assembly 20180 might also be disposed on a curved surface of thecurved base 20185 of the first link 20184 to prevent a joint fromcrushing the user's appendages resting on the curved base 20185. Thus,the sensor assemblies 20180 and control device can beneficially reduceor eliminate injury from accidents involving the robotic arm 20002.Further details about such incident detection systems can be found inWorld Intellectual Property Organization Patent Publication WO2018/18152141, which is hereby incorporated by reference herein in itsentirety.

In one aspect, the sensor assemblies 20180 comprise a curved sensorassembly including: a base housing, a first and a second force sensingresistor assemblies disposed within the base housing, and an interfacemember disposed over the first and second force sensing resistorassemblies. The first and second force sensing resistor assemblies canhave contacts to connect to an associated control device. The controldevice may continuously monitor signals from one or more sensorassemblies 20180 and control the robotic arm 20002 in response to thesignals output by one of the assemblies 20180. Based on these signals,for example, the control device may determine or measure relationshipsbetween the various linkages 20184, 20186, 20188, such as positionalrelationships. This way, virtual interactions about the virtual portpivot can be monitored by the control device to avoid inadvertentaccidents. Furthermore, the force sensing resistor assemblies may haveany suitable shape, including but not limited to rectangular orcircular. The interface member can a substantially curved shape andcomprise a bridge to engage the first and second force sensing resistorassemblies.

Cooperative Engagement Between Robotic Arms

In various aspects, a plurality of robotic arms can be attached to asurgical platform such as a surgical table, on which the patient mayrest during a surgical operation. FIG. 33 depicts a top view of arobotic surgical system 9000 comprising a plurality of robotic arms 9002a, 9002 b, 9002 c, 9002 d, 9002 e each attached to the surgical platform9004. The robotic surgical system 9000 can be similar to other roboticsurgical systems described herein such as robotic surgical system 13000.Although four robotic arms 9002 a-9002 e are shown in FIG. 33 , more orless than four arms can be used as desired for the particular operationbeing performed. As described above, each robotic arm of the 9002 a-9002e could be controlled by its own control device. Alternatively, therobotics arms 9002 a-9002 e can be controlled in conjunction by aconfigurable selective arm base unit. This base unit might be connectedto each of the control devices described above, or the base unit couldcontrol each of the robotic arms 9002 a-9002 e of the robotic directly.To this end, the base unit may be configured to control cooperativeinteractions between various ones of the robotic arms 9002 a-9002 e. Thebase unit may operate as a control circuit, which can be similar in someaspects to control circuits/units described herein. The base unitcontrol circuit can be controlled by a clinician to selectively controla specific one or multiple of the robotic arms 9002 a-9002 e. In oneaspect, the clinician may be a surgeon. Relatedly, there may be multiplemedical personnel present in the surgical environment, such as physicianassistants, anesthesiologists, and nurses (e.g., circulating nurse,scrub nurse, etc.).

The base unit control circuit may comprise a first central controller9006 a for a first surgical robot and a second central controller 9006 bfor a second surgical robot, in which the central controllers 9006a-9006 b are operated together to implement the cooperative engagementof robotic arms 9002 a-9002 e. To this end, each surgical robot cancontrol a subset of the robotic arms 9002 a-9002 e; for example, thefirst surgical robot could control the robotic arms 9002 a-9002 d whilethe second surgical robot controls the robotic arm 9002 e. Thecooperative engagement of the robotic arms 9002 a-9002 e might becontrolled by the base unit control circuit autonomously, in conjunctionwith control inputs by the clinician/surgeon, or by a combination ofautonomous and user control. The first and second controller 9006 a-9006b could be arranged in a master-slave relationship so that the secondsurgical robot operates in response to the second controller 9006 breceiving feedback of the operation of the first surgical robot by thefirst controller 9006 a, for example. Accordingly, both of thecontrollers 9006 a-9006 b may have their own communication modules.Additionally or alternatively, the surgical instruments, tools, ordevices attached to the respective robotic arm may comprise their owncommunication modules. These individual communication modules of thesurgical instruments, tools, or devices can be used to control thecooperative interaction of the arms that these surgical implements areattached to. The base unit control circuit and/or controllers 9006a-9006 b may have similar structural components as the control circuits(e.g., control circuit 760 shown in FIG. 18 ) described above, includingprogrammable microcontrollers, processors, memory circuits, etc. asappropriate, for example.

In general, the base unit control circuit may enable cooperativeoperation of the robotic arms 9002 a-9002 e both within and outside of asterile barrier. For example, the robotic arm 9002 e could be operatingin a non-sterile zone while the robotics arms 9002 a-9002 d operate in asterile zone. Because some of the arms 9002 a-9002 e are operating in asterile zone and others are operating in a non-sterile zone, it may beparticularly important that the robotics arms 9002 a-9002 e operate in acooperative fashion. As depicted in FIG. 33 , a surgeon or cliniciancould be situated at a console to operate the one of the first andsecond controller 9006 a-9006 b. One surgeon could control the consolefor the first controller 9006 a (e.g., that operates in a sterile field)while a different surgeon controls the console for the second controller90006 b (e.g., that operates in a non-sterile field). Each of thecontrollers 9006 a-9006 b could control a subset or all of the roboticarms based on a wired or a wireless connection, as applicable dependingon the surgical procedure being performed. In one aspect, the areaindicated by the sterile boundary demarcation 9008 b is considered anon-sterile field. The areas indicated by non-sterile boundarydemarcations 9008 a, 9008 c, respectively, in the direction extendingfurther away from the patient are also considered non-sterile fields.

As discussed above, the robotic arms 9002 a-9002 e can each releasablyhold, secure and/or control surgical tools, device or instruments forperforming a surgical operation or procedure on the patient. In someaspects, one or more of the group of robotic arms 9002 a-9002 d controlsan anvil of a stapling surgical instrument, which can be similar inoperation to one of the surgical instruments described above such assurgical instrument 20200. The robotic arms 9002 a-9002 d can alsoimplement other aspects of the surgical operation in the sterileabdominal cavity (e.g., other surgical tools or functions) such as usingelectrosurgical forceps or RF surgical instruments to cut and treattissue during a gastrojejunostomy procedure, for example. That is, thesurgical apparatuses held by each robotics arm 9002 a-9002 d can bepassed through a cavity in the surgical environment, such as the sterileabdominal cavity of the patient, to assist in performing the desiredoperation. Conversely, the robotic arm 9002 e controls a surgical devicesuch as a surgical instrument 9010 and may pass through a naturalorifice of the patient, such as the non-sterile anal orifice. Asdiscussed above, each robotic arm may secure an access port, trocar,and/or cannula for insertion of the surgical tool, device orinstrument(s) attached to the robotic arm. The surgical instrument 9010could be a circular stapling surgical instrument. Thus, the base unitcontrol circuit can be used to orient and align the surgical instrument9010 and an anvil held by one of the robotic arms 9002 a-9002 d, forexample, to properly align tissue to be compressed for forming ananastomosis between two types or pieces of tissue during a circularstapling operation. The base unit control circuit could comprise its owncommunication module to output control signals to the robotic arms 9002a-9002 e or the control devices of the robotic arms 9002 a-9002 based onthis communicative coupling.

In particular, the first controller 9006 a may communicate with thesecond controller 9006 b to enable cooperative operation for forming theanastomosis, orienting a camera held by a robotic arm, aligning a tissuefor an ultrasonic instrument to cut, or other suitable surgicaloperations requiring cooperative engagement of robotic arms, forexample. Upon determining a position or adjusted position of each of therobotic arms 9002 a-9002 e, as described in further detail below, thebase unit control circuit could control the robotic arms 9002 a-9002 eto cooperatively interact so that the associated circular stapler andanvil are properly aligned to staple tissue for performing a surgicaloperation. The robotic arms 9002 a-9002 e could be remotely operated.Also, more than one robotic arm can be used to control a surgicaldevice, tool, or instrument, although one robotic arm can be sufficientto secure a single surgical device, tool, or instrument. Additionally tothe robotic arms 9002 a-9002 e, there is also present in the surgicaloperating room of FIG. 33 : an operating room monitor which can besimilar to the primary display 119, an anesthesiologist, a physicianassistant, a circulating nurse, a scrub nurse, a surgeon, and a controltower which can be similar to the hub 106 in FIG. 2 . The control towermay comprise, for example: a camera (e.g., including endoscopic camera),generator like generator module 140, communications like communicationmodule 130, smoke evacuation like smoke evacuation module 126, a modulefor the first surgical robot (first central controller 9006 a), a modulefor the second surgical robot (second central controller 9006 a), and aninsufflator, for example.

In various aspects, the base unit control circuit may be configured tofunction as a control system for executing automated arm-to-armadjustment of the robotic arms 9002 a-9002 e. That is, the base unitcontrol circuit may change or modify the pose of each robotic arm 9002a-9002 e, which includes height and attachment orientation relative tothe surgical platform, as well as changing the spacing between variousones of the robotic arms 9002 a-9002 e (i.e., arm-to-arm spacing). Thisadjustment of arm position and/or orientation could be done autonomouslyby the base unit control circuit. Alternatively, this adjustment couldbe an assisted adjustment that functions as supplemental assistance to asurgeon that is controlling one of the surgical robots being used, suchas via the console of the controllers 9006 a-9006 b. As discussed above,robotic arms 9002 a-9002 e can be coupled to each other and to theirassociated motor via different types of coupling, such as a dual rotaryrod coupling, which can be part of the multi-bar linkage system of therobotic surgical assembly 20030. Using the dual rotary rod coupling, therobotic arms 9002 a-9002 e can be interconnected relative to each other,to the surgical platform, or a floor mount in the surgical environment.The two rods of the dual rotary rod coupling could rotate insynchronization with each other or out of sync, which in turn moves oneor both of the two arms connected via the two rods. This movement may berelative to the bottom of the surgical platform, such as the locationwhere the associated motors of the robotic arms 9002 a-9002 e areattached or housed to the surgical platform. The movement may refer tothe entirety of a robotic arms or certain constituent linkages of therobotic arm such as the linkages 20184, 20186, 20188 described above.When the base unit control circuit determines whether two arms connectedby a dual rotary rod coupling are rotating in sync or out of sync, thebase unit control circuit may control one or both of the robotic arms tomaintain a desired relative position or orientation between the twoarms.

This control by the base unit control circuit may comprise an automatedpositional adjustment. To this end, the base unit control circuit mayreceive positional sensor measurements from sensors such as proximitysensors (e.g., ultrasonic, IR, inductive, capacitive, photoelectric,hall effect senor, etc.) or position sensors that can be similar tosensors described herein, such as the sensor assemblies 20180 disposedon any of the links or holder of a robotic arm. Based on the position orproximity signals, the base unit control circuit can determine the poseof each robotic arm, including the position and orientation of each arm,as well as the positional relationships between various arms such as adistance between a first robotic arm and a second robotic arm of therobotic arms 9002 a-9002 e. In some aspects, the base unit controlcircuit might comprise a powered adjustment tool, which can be poweredby one or more dedicated motors of the robotic surgical assembly 20030.In other words, various motors of the motor pack could each correspondto a connection location of a robotic arm or a linkage of that roboticarm. Each motor could also correspond to a specific distance that arobotic arm or linkage thereof can be adjusted to. Thus, the user of thepowered adjustment tool can use the tool to set up the positioning ofeach robotic arm considered alone or in relationship to another arm. Forexample, each dedicated motor could be used to transfer actuation forcesto an associated adjustment member so that when all of the dedicatedmotors are activated, the various robotic arms 9002 a-9002 e arepositioned at some specific distances therebetween. These specificdistances could be user defined, such as some predetermined distance(e.g., 1 foot) between robotic arms or the some of the constituentlinkages of these robotic arms. Moreover, the adjustment members couldhave integrated or connected sensors that function similarly to thesensor assemblies 20180, so that the surgical robot controlling therobotic arms being adjusted receives an indication of the specificdistances between arms. Consequently, the surgeon controlling therespective controllers 9006 a-9006 b may be provided informationindicating the specific distances that the arms are adjusted to.

As such, the powered adjustment tool may be controlled manually orautomatically by the corresponding surgical robot. Also, thecorresponding surgical robot could itself be controlled by the surgeonusing the surgeon console for the controllers 9006 a-9006. Inconfigurations in which the powered adjustment tool is controlled by thesurgical robot, an electronic lockout mechanism can be provided such asone comprising an electronically actuated fuse, electronic key, switchor other suitable mechanism. The electronic lockout, when activated, mayprevent the robot from moving the corresponding robot arms controlled byit. In this manner, when the powered adjustment tool is adjustingarm-to-arm distances to the specific distance, the robot cannototherwise move the arms. The lockout could also be applicable when armmovement is controlled by the surgeon. Alternatively, some arm movementas specified by the robot or the surgeon could be allowed, but the baseunit control circuit may implement a lower force operational mode thatcompares the force required to move an arm to a force threshold. Thisway, when the arm(s) and adjustment member(s) of the powered adjustmenttool are moved simultaneously, the arm(s) are moved at a slower rate orat a lower maximum force threshold. These functionalities of the baseunit control circuit to adjust the various arms robotic arms 9002 a-9002e can be used for cooperative engagement. Adjustment of arm-to-armdistances can improve the chance of success of the surgical operation.For example, the specific known arm-to-arm distances can help when onearm is holding a camera and the other arm is holding a surgicalinstrument that is being inserted into an access port, when one arm isholding an anvil that needs to be aligned with the surgical staplersecured by the other arm, or when one arm has forceps for gripping atissue bite that needs to be inserted into the end effector of an RFsurgical instrument held by the other arm.

In addition to arm-to-arm adjustments, the base unit control circuit maybe configured to change the pivot position or orientation of any of therobotic arms 9002 a-9002 e relative to the surgical platform. Thischange in motion can be automated or an assist to such control by thesurgeon. Adjustment of pivot position could comprise adjustment of theRCM relative to a virtual port pivot, as described above. Accordingly,the adjusted RCM could then restrain a corresponding arm to a differentsurgical operation space defined by a different pivot point. Thisadjustment to the different RCM could be made by the base unit controlcircuit because the position of the surgical platform has changed, suchas from a horizontal position to a Tredenlenburg position, for example.Other changes in the position of the surgical platform are also possibleand the positions of the respective robotic arms 9002 a-9002 e Theprecise change in incline or decline of the surgical platform could beused to determine the extent that the RCM should be adjusted.Additionally or alternatively, the adjustment of the position of thesurgical platform could be used to change a pose (i.e., position andorientation) of any of the robotic arms 9002 a-9002 e. In this way, therobotic arms 9002 a-9002 e can be adjusted by the base unit controlcircuit to the desired height, orientation, and RCM rotation parametersfor performing the surgical operation on the patient. Making theseadjustments automatically or as an assist to the surgeon when thesurgical platform moves can ensure the surgical procedure proceedssmoothly. These pose adjustments of the robotic arms 9002 a-9002 e canadvantageously reduce or eliminate the risk of interruption when thesurgical platform is inadvertently moved, for example. The initialpositions of the robotic arms 9002 a-9002 e could be determined based onsensor measurements from the proximity or position sensor, for example.

The robotic arms 9002 a-9002 e might be mounted to the surgicalplatform/table as discussed above, or they be mounted to the floor ofthe surgical operating room. The precise mounting arrangement can beincorporated into the adjustment of the pose of the robotic arms 9002a-9002 e. When the patient's head is raised based on the incline of thesurgical platform, for example, kinematic calculations from the controldevice mapped to each of the robotic arms 9002 a-9002 e mounted on thesurgical platform can be used to maintain the pivot and relativeposition of the trocars, access ports, tools, or other implementssecured by the corresponding arm. Also, force thresholds as implementedby the control device or the base unit control circuit can be used basedon force measurements by force sensors such as the sensor assemblies20180 for maintaining pivot and relative position as well. Thus, thebase unit control circuit could change the respective pivot positions ofany robotic arm 9002 a-9002 e based on comparison to applicable forcethresholds to maintain the pivot and relative position. When the arms9002 a-9002 e are mounted to the floor, the arms can be automaticallyraised or lowered depending on the movement of the patient, such as whenthe patient's head is raised. For example, when the patient's head israised based on the incline of the surgical platform, the subset ofrobotic arms 9002 a-9002 e located in an area corresponding to on thatside of the table that is pivoting can be automatically raised.Conversely, the subset of robotic arms 9002 a-9002 e on the other sideof the pivot may be automatically lowered.

The surgical platform 9054 can also be rotatably moved. When theplatform is rotated, the patient could potentially move relative to theplatform 9054. For example, gravity could cause the patient to subtlyshift position. Accordingly, the access ports of the patient may moverelative to the fixed position of the surgical robots and associatedarms performing the procedure, which may result in transverse loadsbeing applied to the associated arms 9002 a-9002 e. To address thisundesired movement of the access ports, the base unit control circuitmay control the motor pack to apply actuating forces to the arms 9002a-9002 e to move so that these transverse loads stay below a certainthreshold. If the actuating forces do not move the robotic arms 9002a-9002 e sufficiently quickly, such that the threshold is exceed, asafety stop could be triggered. For example, the safety stop couldinvolve terminating providing power to the mechanical actuator that iscausing the surgical platform to rotate. The robotic surgical system13000 may inform the medical staff present in the operating room basedon tactile or audible feedback, for example. As such, the base unitcontrol circuit is designed to provide automated or assisted adjustmentof arm support height, attachment orientation, and/or arm-to-arm spacingso that various arms 9002 a-9002 e maintain or adjust their pose so thatthe attached surgical tools, devices or instruments may operate properlyon the patient, individually as well as cooperatively.

In various aspects, the robotic surgical system 13000 may includemultiple individual trocar locations, in which the trocars can beoperatively similar to the trocar 20250, for example. In addition, someof these multiple trocars and associated robotic arms can be eitherlocated within a sterile space or a non-sterile space. At least one ofthe robotic arms may be designed to operate outside of the sterilespace, for example. FIGS. 34A-34B illustrate an example of such arobotic configuration. As shown in the top views of FIGS. 34A-34B, arobotic surgical system 9050 which can be similar to robotic surgicalsystem 9000, comprising a plurality of robotic arms 9052 a-9052 e eachattached to the surgical platform 9054. The robotic arms 9052 a-9052 eand surgical platform 9054 may be similar to the robotic arms 9002a-9002 e and surgical platform 9002 described above. First and secondcentral controllers 9056 a-9056 b can be similar to the first and secondcontroller 9006 a-9006 b described above. Also, each of the non-sterileboundary demarcations 9058 a-9058 c demarcate sterile and non-sterileareas as described above. Similar to above, the surgical environment inFIGS. 34A-34B include an operating room monitor, an anesthesiologist, aphysician assistant, a circulating nurse, a scrub nurse, a surgeon, anda control tower. FIG. 34A portrays multiple trocars 9060 a-9060 cpositioned in various locations about the cavity of the patient, such asthe abdominal cavity. The abdominal cavity may refer to an internal wallrelative to a surgical incision. As indicated by the non-sterileboundary demarcations 9058 a-9058 c, the trocars 9060 a-9060 c are alllocated in a sterile zone. Conversely, the trocar 9060 e is located in anon-sterile zone, as indicated by the non-sterile bounded area ofnon-sterile boundary demarcations 9058 b.

Cooperative engagement of the robotic arms 9052 a-9052 e controlled bythe base unit control circuit, therefore, can be used to ensure thesterile trocars do not intermingle with the non-sterile trocars. Suchintermixing could be detrimental to the patient's health and thereforeit is beneficial to avoid this intermixing via cooperative engagement ofthe arms. Additionally, for the same reason, the robotic arms can becooperatively controlled so that robotic arms 9052 a-9052 d operating ina sterile field do not touch or come within undesirably close proximityto the robotic arm 9052 e operating in a non-sterile filed, for example.The trocars 9060 a-9060 c, 9060 e can each be coupled to theirrespective robotic arms 9052 a-9052 c, 9052 e, which can be attached ina relationship like the trocar 20250 to robotic arm 20002 discussedabove. An auxiliary trocar port 9062 may be provided and used, dependingon the surgical incision and operation being performed. The placement ofthe trocars 9060 a-9060 c, 9062 e and auxiliary trocar port 9062 shownin FIG. 34A is merely illustrative and such placement depends on thesurgical operation being performed, such as a laparoscopic orgynecological operation, for example. The trocars may be placed orinserted within a lumen or other area relative to a surgical incisionsuch as a semilunar or straight incision.

FIG. 34B shows one example of two surgical robots each controlling asubset of the robotic arms 9052 a-9052 e to perform a surgicalprocedure, such as a laparoscopic surgery. In one aspect, the firstcontroller 9056 a of the base unit control circuit may control a firstsurgical robot 9057 a, which may control the subset of sterile roboticarms 9052 a-9052 d, for example. The controller 9056 b of the base unitcontrol circuit may control a second surgical robot 9057 b, which maycontrol the non-sterile robotic arm 9052 e, for example. The controller9056 a-9056 b can function as consoles for surgeons or might not beprovided altogether such as controller 9056 b in FIG. 34B. Consequently,the second surgical robot 9057 b could be remotely or teleoperativelycontrolled or autonomously controlled. Each of the first and secondcontroller 9056 a-9056 b and/or first and second surgical robot 9057a-9057 b may have their own communication modules. In this way, they cancommunicate with their respective subset of robotic arms 9052 a-9052 eas well as with each other to implement the base unit control circuitfor cooperative engagement as described above. In some aspects, thesecond surgical robot 9057 b controls a circular stapling instrument(including the staple cartridge thereof) secured by the robotic arm 9052e in the non-sterile space while the first surgical robot 9057 acontrols the surgical tools, instruments, or devices secured by therobotic arms 9052 a-9052 d. For example, the robotic arm 9052 a maysecure a bipolar ultrasonic instrument, the robotic arm 9052 b couldsecurably hold another surgical stapler, the robotic arm 9052 csecurably hold a grasper or retracter, and the robotic arm 9052 dsecurably hold a scope (e.g., endoscope). The robotics arm 9052 a-9052 ecould cooperatively interact or engage with each other to treat tissuewithout mixing operations in sterile and non-sterile fields,respectively. Such tissue treatment can be for various surgical ormedical procedures, as appropriate.

In one specific example, the cooperatively interacting robotic arms 9052a-9052 e could be used for a colorectal configuration, such as thatinvolving a multiquadrant arrangement with multiple surgical robots fora low anterior resection (LAR) procedure. The LAR procedure orcolorectal configuration generally may be used for treating colorectaldiseases such as colon/rectal polyps, diverticular disease, and cancer.The LAR procedure may be performed laparoscopically or as an openprocedure. For a LAR procedure or a sigmoidectomy, for example, thesurgical procedure may involve multi-quadrant manipulation andmobilization by the cooperatively engaging robotic arms 9052 a-9052 e.Upon properly placing the patient relative to the surgical platform andinsufflating the patient's abdomen via an insufflator, it is necessaryto place trocars 9060 a-9060 e and auxiliary trocar port 9062, as shownin FIG. 35 .

In the diagram 9100 of FIG. 35 , trocar 9060 a is positioned in thecenter of the abdominal cavity, trocar 9060 b is positioned on a lowerportion of the descending colon, trocar 9060 c is positioned proximateto a junction of the transverse colon and the ascending colon, trocar9060 d is positioned proximate to the ribcage, trocar 9060 e ispositioned proximate to the rectum, and the auxiliary trocar port 9062is positioned on an upper portion of the descending colon. The trocars9060 a-9060 e and auxiliary trocar port 9062 function as access portsfor their respective robotic arms 9052 a-9052 e. As discussed above andrepresented by the dashed lines passing through the trocars 9060 a-9060e, each robotic arm 9052 a-9052 e secures a surgical implement. Forexample, the robotic arm 9052 a may hold an electrosurgical energysurgical tool, the robotic arm 9052 b may hold a grasper tool or asurgical stapling instrument, the robotic arm 9052 c may hold a scopesurgical tool, the robotic arm 9052 d may hold a grasper tool, and therobotic arm 9052 e may hold a circular surgical stapler. The roboticarms 9052 a-9052 e may cooperatively work within the delineated workingarea 9111 for performing surgical operations. In addition, for acolorectal procedure, the depicted portions of the patient's anatomycould be divided into four quadrants, as indicated by upper leftquadrant 9110 a, upper right quadrant 9110 b, lower left quadrant 9110c, and lower right quadrant 9110 d. The “x” in FIG. 35 represents thelocation of the patient's umbilicus.

FIGS. 36A-36B depict an example of a resection and mobilization step ofLAR procedure being performed, in which the resection and mobilizationis performed in the upper quadrants 9110 a-9110 b. During the LAR, thesurgeon may control the robotic arms 9052 a-9052 e to perform a smallintestine/bowel relocation, retraction, and/or dissection step.Subsequently, the robotic arms 9052 a-9052 e may perform largeintestine/colon. In particular, the robotic arms 9052 a-9052 e mayexecute complete mobilization of the splenic flexure as well aslaterally or medially mobilize the transverse colon (or a portionthereof), for example. To this end, the grasper held by robotic arm 9052d may extend through trocar 9060 b to grasp a portion proximate to thetransverse colon in the upper right quadrant 9110 b. The robotic arm9052 b may also be controlled by the base unit control circuit to graspand retract another portion of the transverse colon in the upper leftquadrant 9110 a. Furthermore, the electrosurgical energy surgicalinstrument secured by the robotic arm 9052 a could be used to treattissue (e.g., coagulate, seal, cut, etc.) in support of the colonmobilization. The scope held by the robotic arm 9052 c may be used forvisualization.

Accordingly, the base unit control circuit can control the robotic arms9052 a-9052 e in cooperative engagement to perform surgical steps acrossmultiple surgical quadrants, in which the arms could be passable throughdifferent quadrants to perform different surgical operations. Forexample, one robotic arm could be passed through a first quadrant (e.g.,via a trocar) for resection or cutting etc., while another robotic armcould be passed through a second different quadrant for moving orviewing tissue, etc. In particular, passing through the first quadrantcould involve passing within a cavity of the patient while passingthrough the second quadrant could involve passing through an orifice ofthe patient. Also, the first quadrant could be a sterile quadrant whileat least some portion of the second quadrant could be non-sterile orcontain a non-sterile surgical implement. One or more robotic arms couldbe located in a sterile zone or a non-sterile zone, as appropriate, asdiscussed above. Similarly to the example operation in the upperquadrant, the robotic arms 9052 a-9052 e could be controlled to operatein conjunction in the lower quadrant. As part of a resection ordissection process, a first portion of the small bowel in the upperquadrant can be replaced and a second portion of the small bowel in thelower quadrant can be relocated. This could involve lateral mobilizationof the descending and sigmoid colon and dividing the rectum, forexample. Lower quadrant mobilization of the colon can occur for vascularisolation of a portion of tissue to be resected.

FIGS. 36B and 37 show positioning by the robotic arms 9052 a-9052 e fora circular stapling operation for forming an anastomosis to rejoinportions of the colon and/or small intestine that were dissected forsurgical treatment. In FIG. 36A, the grasper/retractor 9150 d held byrobotic arm 9052 d grasps mobilized and/or resected portions of thecolon, while the grasper 9150 b held by robotic arm 9052 d may graspand/or pull down the detachable anvil of the circular staplinginstrument 9150 e held by the robotic arm 9052 e. The scope 9150 c heldby robotic arm 9052 c may be used to help visualize the circularstapling/anastomosis step. The operation as depicted in FIG. 36A may beprimarily be performed in lower colorectal quadrants, such as in lowerleft quadrant 9110 c and lower right quadrant 9110 d. In one aspect, theproximal transected portion of the rectum is moved toward the rectum.The base unit control circuit and/or surgeon may then control thecooperatively interacting robotic arms 9052 a-9052 e for performing thestapling operation. The base unit control circuit may control therobotic arms 9052 a-9052 e so that they cooperatively reposition thetransected upper colon portion to be adjacent to the rectal portion forconnection to the circular stapler 9150 e relative to a proposedanastomotic site.

Preceding this alignment and repositioning step may be a step forassessing the perfusion of the proposed anastomotic site. Once therobotic arms 9052 a-9052 e are controlled to properly align the anvilheld by the grasper 9150 b and the circular stapling instrument 9150 e,the surgeon may determine the proper extent to compress the two piecesof tissue to be used to form the anastomosis. Subsequently, the circularstapling instrument 9150 e may be fired and a ring of staples ejectedfrom the staple cartridge of the circular stapling instrument 9150 erelative to the anvil to form the anastomosis. The formed colorectalanastomosis may then be tested. Before performing the anastomosis, theelectrosurgical energy surgical instrument 9150 a held by robotic arm9052 a may be used to perform small bowel relocation and retraction asshown in FIG. 36B. Unlike FIG. 36A, this operation as depicted in FIG.36B may be primarily be performed in upper colorectal quadrants, such asin upper left quadrant 9110 a and upper right quadrant 9110 b. Thegrasper/retractor 9150 d held by robotic arm 9052 d may grasp mobilizedand/or resected portions of the large colon. The scope 9150 c held byrobotic arm 9052 c may be used to for visualization and the grasper 9150b held by robotic arm 9052 d may grasp tissue to assist treatment oftissue proximal to the transverse colon in the upper right quadrant 9110b by the electrosurgical energy surgical instrument 9150 a. Accordingly,the robotic arms 9052 a-9052 e may be cooperatively controlled to workwithin or across multiple quadrants.

FIG. 37 illustrates how the base unit control circuit may control therobotic arms 9052 a-9052 f to cooperatively form the anastomosis whileaddressing the fact that robotic arms 9052 a-9052 d, 9052 f are sterilewhile robotic arm 9052 e is non-sterile, for example. As discussedabove, the robotic arm 9052 e could be controlled by a differentsurgical robot than the robotic arms 9052 a-9052 d, 9052 f. Also asdiscussed above, the base unit control circuit may monitor and adjustarm pose and/or arm-to-arm spacing so that the multiple robotic arms9052 a-9052 f do not entangle among themselves while lining up the anviland/or trocar 9060 b to the patient's rectum and/or the circular stapler9150 e prior to firing the circular stapling instrument 9150 e. As shownin FIG. 37 , the robotic arms 9052 a-9052 d, 9052 f may each hold somesterile surgical tool, device, or instrument for assisting in the LARprocedure, including transecting and/or mobilizing the patient's colonacross the upper and lower quadrants. The surgical implements 9150a-9150 d, 9150 f held by robotic arms 9052 a-9052 d, 9052 f may each besterile. Accordingly, when the base unit control circuit ensuressurgical implements 9150 a-9150 d, 9150 f or their corresponding roboticarms do not intermix with the circular stapling instrument 9150 e, thismay be beneficial to the patient's health and to the success of thesurgical operation. As discussed above, the base unit control circuitmay adjust robotic arm support height. For example, as shown in FIG. 37, the base unit control circuit may control the robotic arm 9052 e toensure the height, pose or other positional characteristic of therobotic arm 9052 e or linkages thereof stay within the threshold a2.

Similarly, the base unit control circuit may implement a safetythreshold a2 or some other threshold to maintain a safe or desirablearm-to-arm spacing. To this end, the base unit control circuit mayidentify or determine when safety threshold a2 is violated, such as thesafety margin violation 9153 represented between robotic arms 9052 a and9052 c. Alternatively, the safety violation 9153 could refer to thedistance between surgical implement 9150 a and 9150 c. Also, the safetyviolation 9153 could refer to problematic distances between variousrobotic arms 9052 a-9052 e and sterile zone boundaries. In allscenarios, the base unit control circuit may alert the surgeon/clinicianthat this violation 9153 has occurred, which can improve the safety andefficacy of the surgical operation being performed. This alert may takethe form of audible or tactile feedback at the first and second centralcontrollers 9056 a-9056 b, for example. FIGS. 38A-38B show exampleconfiguration of cooperating robotic arms 9152 a-9152 e to mobilize thecolon and perform anastomosis, respectively, for a LAR operation. Asdescribed above, electrosurgical energy surgical instrument 9150 a,grasper 9150 b, scope 9150 c, grasper 9150 d, and circular staplinginstrument 9150 e may be secured or held by cooperatively interactingrobotic arms 9152 a-9152 e. The surgical implements held by robotic arms9152 a-9152 e described herein are merely examples and could be othersurgical implements as appropriate and desired according to the surgicalprocedure being performed.

Determining or Adjusting Pose of Insufflation Ports

In various aspects, the positioning, alignment, gripping, and/or pose ofvarious access ports (e.g., access port 20254) and trocars (e.g., trocar20250, 9060 a-9060 e) described herein may be controlled or adjusted tofacilitate the performance of a surgical operation. As discussed above,any of the robotic arms (e.g., robotic arms 9152 a-9152 e) describedherein may have a mounting device (e.g., mounting device 20230) and/orclamping assembly (e.g., clamping assembly 20234) securably attached tothem. As shown in FIG. 39 , mounting device 20600, which can be similarin operation to mounting device 20230, may includes a housing whichsupports a clamping assembly 20640 (which can be similar in operation toclamping assembly 20234) and a release mechanism 20660. A distal surfaceof the housing may further define a receiving recess 20622 which isconfigured to complement an exterior profile of an access device, suchthat the access device may be positioned in near abutment to, orapproximated within the housing of the mounting device 20600. Therelease mechanism 20660 may be actuatable between an initial positionand a release position, in which the release position enables theclamping assembly 20640 to transition to an open configuration so thatan access device (e.g., trocar, surgical port) previously securedtherein can be removed from surgical mounting device 20600.

As shown in FIG. 39 , the clamping assembly 20640 includes a firstclamping arm 20641 positioned opposite a second clamping arm 20645, anda plunger assembly 20648 positioned therebetween. The clamping links20655 a-20665 b can have two throughholes and pivotably interconnecteach of the first and second clamping arms 20641, 20645. A biasingmember 20653 a may act to bias the first and second clamping arms 20641,20645 into the open position, which is overcome as the clamping assembly20640 transitions into the closed configuration. Each of the first andsecond clamping arms 20641, 20645 may further include a cover or sleevec configured to slidably engage with the respective distal portion ofthe clamping arms 20641, 20645. At least one of the clamping links 20655a-20665 b may pivotably interconnect the first and second clamping arms20641, 20645 to the drive member 20649. The plunger assembly 20648 mayfurther include another biasing member 20653 b to a bias a middlesegment 20650 with respect to the drive member 20649. To this end, thedrive member 20649 may be connected to the middle segment 20650 via acoupling bar 20652, which may further include a threaded post or stem20656 extending distally from the coupling distal end 20654. FIG. 40illustrates how a first pin P1 is disposed within a first through-holeand a second pin P2 is disposed within a second through-hole of theclamping links 20655 a-20665 b, such that clamping links 20655 a-20665 bare coupled to drive member 20649. Additional through-holes can bedisposed on the clamping assembly 20640, including the cover or sleeve20642 a-20642 b, as desired and as depicted in FIG. 40 . The covers20642 a-20642 b may further include a protruding ridge, rib, or shoulder20643 a-20643 b disposed along the exterior contour 20644 a-20644 bconfigured to engage a corresponding channel or surface of an accessdevice or trocar, for example.

FIGS. 41A-41B depict operation of the clamping assembly 20640 in anunlocked and a locked configuration respectively. In the unlockedconfiguration, an access device, such as the trocar T portrayed in FIGS.41A-41B, can be received. Correspondingly, in the locked configuration,the trocar T is secured by the clamping assembly 20640 in FIG. 41B. Thetrocar T is merely an example trocar and may be similar in operation toany of the trocars described herein. The receiving surface of the firstclamping arm 20641 may provide an arcuate profile which complements theexternal profile of trocar T, such that trocar T may be receivedtherein, as can be seen in FIGS. 41A-41B. The clamping assembly 20640 istransitionable between an open, or unlocked, configuration of FIG. 41Aand a closed, locked, configuration of FIG. 41B, for example. Thepivoting of first and second clamping arms 20641, 20645 and thetranslation of drive member 20649 and middle segment 20650 correspond tothe transition of the clamping assembly 20640 between the open andclosed configurations. The first and second clamping arms 20641, 20645may be pivotable about the through-hole(s) corresponding to axis Y₁ andY₂ respectively, between a spaced apart position in FIG. 41A and anapproximated position in FIG. 41B relative to one another. Additionally,the drive member 20649 and middle segment 20650 coupled therewith aretranslatable between a distal position in FIG. 41A and a proximalposition in FIG. 41B, as indicated by arrows Z₁ and Z₂. In the openconfiguration of clamping assembly 20640, first and second clamping arms20641, 20645 are in the spaced apart position and drive member 20649 andmiddle segment 20650 are in the distal position. In the closedconfiguration of clamping assembly 20640, first and second arms 20641,20645 are in the approximated position and drive member 20649 and middlesegment 20650 are in the proximal position.

The drive member 20649 may be connected to a motor or a motor pack(which can be similar in operation to motors described herein such asmotor 20408), servo, electro-controller, or any other suitable means toachieve automated translation of drive member 20649 in the direction ofarrow Z₁. That is, the motor may drive the translation of the drivemember 20649 from the distal position to the proximal position. Acontroller could be included, such as on the associated robotic arm, tooperate the motor remotely. As the drive member 20649 translates middlesegment 20650 distally into the distal position and first and secondarms 20641, 20645 are pivoted into the spaced apart position, theclamping assembly 20640 is thus translated into the open configuration.The release mechanism 20660 is actuatable between an initial positionand a release position. In the release position, release mechanism 20660is actuated in the direction of arrow R and the contact surface ofrelease mechanism 600 comes into abutment with the drive member 20649,such that the drive member 20649 is urged to translate into the distalposition in the direction of Z₂. As the drive member 20649 translates tothe distal position, the middle segment 20650 concurrently translatesinto the distal position and the first and second arms 20641, 20645pivot about axis Y₁ and Y₂ respectively into the spaced apart position.This transitions clamping assembly 20640 into the open configuration.With clamping assembly 20640 in the open configuration, the accessdevice previously secured therein can be removed from surgical mountingdevice 20600. Further details about the mounting and clamping devicesmay be found in U.S. Patent Publication 2018/0177557, which is herebyincorporated by reference in its entirety.

In some aspects, the controller, control device, base unit controlcircuit, or other control means described herein can function as atracking means for the access device or other portion of the roboticsurgical assembly 20030. For the sake of clarity, the tracking meanswill be described herein as being performed by the base unit controlcircuit. To function as the tracking means, the base unit controlcircuit may control various tracking sensors, such as mechanical,optical, electromagnetic sensors, or other suitable tracking devices.These sensors could be designed to have high robustness such asresistance to impairment or negative effects by the surroundingenvironment. For example, the tracking sensors may include magneticsensors constructed of amorphous ferromagnetic materials, which mayimprove the reliability of such magnetic sensors in harsh environmentsbased on having a good response to changes to magnetic permeability ormagnetization direction. Similarly, light and sound (e.g., ultrasonicsensors) may have weather resistant coatings or other chemicallyresistant coatings such as parylene coatings, for example, forprotection in harsh environments. Preferably, the accuracy of thetracking sensors may also be high, such as at resolutions of less than0.1 mm, for example. In one aspect, multiple tracking sensors may bedisposed about the robotic surgical assembly 20030 and the base unitcontrol circuit may track these multiple sensors concurrently. Therefresh rate of the tracking means can be approximately 100 Hertz (Hz)with a latency of less than 1 millisecond (ms), for example.

The base unit control circuit could be configured to control the accessdevices' pose—position or orientation of the insufflation ports of therobotic arms used in a surgical procedure relative to the patient'sabdominal wall and/or trocar gripping system—for a LAR procedure, forexample. The insufflation ports' pose may be controlled to minimizeconstricting of the gas supply or pressure and inadvertent impingementon the adjacent body wall. The trocars of the robotic arms used forinsufflation of the patient's abdomen could each have a trocar sleevethat includes a stop-cock valve mechanically interfitted between atrocar cannula (e.g., similar to cannula 20252) and a trocar housing.The stop-cock valve can be positioned in communication with the trocarcannula for selectively allowing and preventing the passage of aninsufflation fluid, e.g. carbon dioxide, through flexible tubing into aportion of the trocar cannula. Each stop-cock valve may be mechanicallyor otherwise secured to each trocar; for example, ultrasonic welding oradhesives could be used for the attachment. During an LAR procedure asdescribed above in which the robotic arms 9152 a-9152 e are used, forexample, the base unit control circuit (or control device(s) describedabove) may be programmed to determine the orientation of each trocarattached to the corresponding robotic arms 9152 a-9152 e. To achievethis, the tracking sensors—could be similar in some aspects to thesensor assemblies 20180—may output sensor signals based on ultrasonicpulses, magnetic signatures, etc. depending on the tracking means usedin order to sense the orientation of each trocar.

Thus, for each surgical robot controlling one or more of the roboticarms 9152 a-9152 e, the locations of the trocars and specifically thelocation of the attached stop-cock valves can be defined for thepurposes of control by the base unit control circuit. This definedlocation may be advantageous for controlling the robotic arms 9152a-9152 e and/or robotic surgical system 1300 generally so thatunnecessary damage to the patient is reduced or avoided altogether. Forexample, the base unit control circuit may execute control algorithms toprevent surgical robots from pressing the stop-cock valves into thepatient. For example, a control algorithm could be executed to limitmotion of the robotic arms 9152 a-9152 e or linkages thereof in one ormore directions. As such, position, proximity or other suitable sensors(could be similar to mounted sensor assemblies 20180) mounted on therobotic surgical assembly 20030 can provide data to the base unitcontrol circuit to stop arm motions in a certain direction when the dataindicates that the arm motion exceeds a certain limit or threshold. Thisway, the base unit control circuit can prevent the stop-cock valve frominjuring the patient. Additionally, the base unit control circuit can besituationally aware to facilitate such a control algorithm. For example,information about the particular surgical procedure being performedand/or input information from operating room staff can be used to informthe positioning of the patient relative to the surgical platform androbotic surgical assembly 20030 during performance of the surgicalprocedure. This information may help the surgical robots involved inexecuting the procedure to set control limits on robotic motions.

FIGS. 42A-42D illustrate one example of a tracking means and controlledalgorithm executed by the base unit control circuit to sense trocar poseand other useful positional information. At least one Hall effect sensor9200, as indicated in FIG. 42A, can be provided to detect suchinformation. For example, the Hall effect sensor 9200 may detect thealignment and configuration of the trocar 9205, which can be similar insome aspects to trocars described above such as trocar 20250 and trocars9060 a-9062 e. The Hall effect sensor 9200 may output an output signalthat is a function of the surrounding magnetic field density that isaffected by the one or more correlated field magnet(s) 9215. Theexternal magnetic field of the correlated field magnets 9215 may be usedto activate and cause the Hall effect sensor 9200 to generate an outputHall voltage. The correlated field magnets 9215 may be used for variousmagnet movements such as head-on, sideways, push-pull, pull-push, etc.in connection with the Hall effect sensor 9200 detecting proximity,movement, position etc. Also, the correlated field magnets 9215 maygenerate a magnetic signature in which the correlated field magneticsignature may be used to identity the type of the trocar 9205. Trocartype might include laparoscopic, bladed, optical trocar types, forexample. Accordingly, the base unit control circuit may operate inconjunction with the Hall effect sensor 9200 to identify trocar type,trocar pose, and/or other relative positional information.

The magnetic signature varies depending on the number and placement ofthe correlated field magnet(s) 9215, for example. In FIG. 42B, themagnetic signature 9230 of the correlated field magnet(s) 9215 mayindicate a 8 millimeter (mm) trocar 9205 with a stop-cock valve that isaligned. The magnetic signature 9235 in FIG. 42C could indicate a 8 mmtrocar 9205 with no stop-cock valve. And in FIG. 42D, the magneticsignature 9240 could indicate a 5 mm trocar 9205 without a stop-cockvalve. The Hall effect sensor 9200 may be disposed between the first andsecond clamping arms 9221, 9225 (can be similar to clamping arms 20641,20645) and distal to the middle segment 9235 (can be similar to middlesegment 2065). The first and second clamping arms 9221, 9225 may operateas part of a clamping device to secure the trocar 9205, as discussedabove. FIGS. 43A-43E illustrate the Hall effector sensor 9200 being usedto sense the particular magnetic signature of the trocar 9205, whichenables the sensor 9200 to sense the number/pattern of magnets 9215 andtheir relative position to the sensor 9200. The configurations of FIGS.43A-43C may correspond to the magnetic signatures of FIGS. 42B-42D. Themagnetic signature 9230 of the correlated field magnet(s) 9215 mayindicate a 8 millimeter (mm) trocar 9205 with a stop-cock valve 9250that is aligned in FIG. 43A. The magnetic signature 9235 in FIG. 43Bcould indicate a 8 mm trocar 9205 without the stop-cock valve 9250. InFIG. 43C, the magnetic signature 9240 could indicate a 5 mm trocar 9205without the stop-cock valve 9250.

FIGS. 43D-43E depict the Hall effect sensor 9200 and base unit controlunit may identify trocar alignment and trocar configuration so that thisinformation is obtained to facilitate surgical treatment and to avoidinjury to the patient based on the position of the trocar 9205, forexample. FIGS. 44A-44C illustrate how visual cues could be provided forthe tracking means and/or base unit control unit to determine theidentity, orientation, and other positional information of the trocar9305 (similar to trocars described herein) relative to robot arm 9302(similar to robot arms described herein). In FIG. 44A, a tracking sensorsuch as an optical sensor could read/sense the matrix bar code 9308 inwhich the optical detection of 9308 is used to identify the identity andpose of trocar 9305, for example. The corresponding trocar 9305 withstop-cock valve 9350 and code 9308 is shown in FIG. 44A. In FIG. 44B,the robotic arm 9302 may secure a laser source 9300 attached to the arm9302 and/or a linear slide such as the sliders or rails (e.g., rail20040) described above. The laser source 9300 may emit a laser or someother form of light so that the light detector 9317 can be used for thetrocar 9305 identification and detection described herein. Inparticular, the emitted light may contact recessed grooves 9319, whichmay cause a different diffraction or dispersal of light. The emittedlight from laser source 9300 may reflect differently in such a way toencode trocar information that can be detected by the light detector9317. The light emission and detection are indicated by the dashed linesin FIG. 44B. The trocar 9305 in FIG. 44B is gripped by the clamping arms9321, 9325. In FIG. 44C, another bar code 9309 is shown as a method tooptically sense and determine the type and positional information of thetrocar 9305 as well as the presence and position of stop-cock valve9350. The bar codes 9308-9309 could each be some suitable type ofreadable optical code, including quick response (QR) codes, for example.

Accordingly, the tracking means and base unit control circuit may beconfigured to determine the pose of the trocar 9305 and stop-cock valve9350 for improving patient safety and the effectiveness of the surgicaloperation being performed, as described herein. Moreover, the controlalgorithm may be performed so that a history of the rotations made by arobotic arm is retained, such as by being stored within a memory circuitof the base unit control circuit. In this manner, the control algorithmmay be executed to ensure an insufflation hose does not undesirably wraparound a tool, trocar, or other part of robotic surgical assembly 20030.Relatedly, the robotic arm holding the trocar may have the ability torotate the trocar within the associated trocar holder to ensure theassociated stop-cock valve is not in a position to accidentally injurethe patient. Alternatively, the trocar may have a unique orientationwhen inserted into the corresponding robot arm. In such a scenario, theposition of the stop-cock valve would be known based on this uniqueorientation. FIG. 45 illustrates an access device including a cannula20700, which could be similar to cannulas described herein such ascannula 20252. The cannula 20700 may include an attachment portion 20761having an array 20762 including a plurality of magnet positions 20764for one or more magnets, as depicted in FIG. 45 . An positioningidentification device or other tracking means can be used to determineposition of a stop-cock valve based on the plurality of magnet positions20764, for example. Further details about the configuration depicted inFIG. 45 may be found in U.S. Patent Publication 2017/0105811, which ishereby incorporated by reference in its entirety.

In various aspects, the insulation tubing of an insufflator may beattached to the outside of a gripping member held by a robotic armcontrolled by a surgical robot. The robotic arm or snap in features of asterile feature can be provided to manage this insufflation tubing. Theinsufflation could be an abdominal insufflation for a LAR colorectalprocedural, as described above. FIG. 46A-46B illustrate the managementof the insufflation tubing 9403 which passes through the interior of therobotic arm 9402, in which the insufflation tubing 9403 is locatedwithin a sterile barrier 9409. Accordingly, it may be desirable tocontrol the robotic arm 9402 to avoid entanglement with a non-sterilebarrier, as discussed above. The sterile barrier 9409 may surround orencompass the robotic arm 9402, as depicted in FIG. 46A. Airflow oranother suitable fluid may enter the insufflation tubing 9403 into apatient body cavity such as an abdominal cavity as part of surgicaltreatment. Clips 9417 a-9417 e may be used to attach to eachsegment/linkage 9484, 9486, 9488 of the robotic arm 9402 so that theinsufflation tubing 9403 may be held in place. The robotic arm 9402 maysecure a surgical implement 9450 at a distal end of the robotic arm9402, in contrast to the proximal end of the robotic arm 9433.

FIG. 46B shows a sectional view of a section of the insufflation tubing9403 with a clip 9417 a used to secure the section of tubing 9403against a section of housing 9423 of the robotic arm 9433. Theattachment of the insufflation tubing 9403 to both the distal end of thelinear slider/rail as well as the rest of the robotic arm 9433 mayenable the base unit control circuit to move the robotic arm 9433 tomove around the surgical environment for treating the patient whileminimizing the likelihood of damage to the patient. For example, theconfiguration may allow the base unit control circuit to reduce orprevent instances causing potentially damage to the tissue such asaddressing the risk of the insufflation port of the trocar being pinchedagainst a wall of the patient's body. The configuration of FIG. 46Bcould also minimize the pinching of the insufflation tubing 9403 itselfby the corresponding surgical robot. Similarly, potential pinchingbetween the robot and the patient that may cause a loss ofinsufflation—insufflation fluid entering the tubing 9403—may be avoided.Also, a trocar with a vertically oriented insufflation port relative tothe robot could the perimeter of the trocar from having extendingelements that could be driven into the wall of the patient's body. Insituations in which the insufflation is vertically oriented, thephysical attachment of the tubing 9403 to the distal end of the linearslider of the robotic arm 9433 (where the trocar gripper is located) mayhelp manage the tubing 9403 and prevent entanglement. Furtherattachments of the tubing 9403 to the arm 9433 would link management ofthe tubing with the sterile barrier attachment. Consequently thisarrangement may minimize entanglement with any other movable joints andthe robotic arm 9433 itself.

FIG. 47 shows an access device such as cannula 9507 (which can besimilar in some aspects to other cannulas described herein) can be ascrew-on cannula 9507 onto a robotic arm. The cannula 9507 could bedisposable and plastic, for example. A robotic arm holding feature, suchas a robotic clamp 9517 may be provided. The robotic clamp 9517 may bere-processable and metal, for example. The robotic clamp 9517 may beused so that a portion of the insufflation tubing 9518 is in an alignedposition relative to the cannula 9507 and/or associated trocar, but theportion of the insufflation tubing 9518 is not fully coincident to theaxis of the cannula 9507. This way, this may facilitate robotic armcooperative engagement and management as described herein. Accordingly,the cannula 9507 may be parallel but not coincident to the insufflationtubing 9518. This parallel relationship may be for an alignedorientation of the cannula 9507 and/or trocar axis with the insufflationtubing 9518 so that the slide axis (e.g., sliders or rails of a roboticarm as described herein) of the surgical tool driver held by the roboticarm is aligned with the cannula 9507. Furthermore, three seals 9527,9537, 9547 can be provided to seal the robotic clamp 9517. The seals9527, 9537, 9547 may be disposable. The first seal 9527 may be a scraperthat wipes, wicks, and absorbs fluid. The second seal 9537 may be aduckbill for the surgical instrument/tool held by the robotic arm forproviding one way movement of the fluid. The third seal 9547 may be aninstrument lip seal.

While several forms have been illustrated and described, it is not theintention of the applicant to restrict or limit the scope of theappended claims to such detail. Numerous modifications, variations,changes, substitutions, combinations, and equivalents to those forms maybe implemented and will occur to those skilled in the art withoutdeparting from the scope of the present disclosure. Moreover, thestructure of each element associated with the described forms can bealternatively described as a means for providing the function performedby the element. Also, where materials are disclosed for certaincomponents, other materials may be used. It is therefore to beunderstood that the foregoing description and the appended claims areintended to cover all such modifications, combinations, and variationsas falling within the scope of the disclosed forms. The appended claimsare intended to cover all such modifications, variations, changes,substitutions, modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor comprising one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

What is claimed is:
 1. A robotic surgical system for treating a patient,the robotic surgical system comprising: a first robotic arm configuredto control a surgical instrument extending therefrom, wherein thesurgical instrument is configured to be positioned within a cavity ofthe patient, and wherein the first robotic arm is attached to a surgicalplatform in a sterile zone; a second robotic arm configured to control asurgical device extending therefrom, wherein the surgical device isconfigured to pass through a natural orifice of the patient, and whereinthe second robotic arm is attached to the surgical platform in anon-sterile zone; and a control circuit configured to communicativelycouple to the first and the second robotic arm, wherein the controlcircuit is further configured to: determine a first position of thefirst robotic arm and a second position of the second robotic arm; causethe first robotic arm to automatically change from the first position toa third position and to change an orientation of the first robotic armbased on an adjustment of a platform position of the surgical platform;cause the second robotic arm to automatically change from the secondposition to a fourth position and to change an orientation of the secondrobotic arm based on the adjustment of the platform position of thesurgical platform; and control the first robotic arm and the secondrobotic arm to cooperatively interact to perform a surgical operationacross the sterile zone and the non-sterile zone.
 2. The roboticsurgical system of claim 1, wherein: the surgical instrument comprises afirst communication module; and the surgical device comprises a secondcommunication module to communicate with the surgical instrument; thecontrol circuit is configured to control the cooperative interaction ofthe first robotic arm and the second robotic arm based on communicationsbetween the surgical instrument and the surgical device.
 3. The roboticsurgical system of claim 1, wherein the surgical instrument is acircular stapler.
 4. The robotic surgical system of claim 3, wherein thesurgical device is an anvil.
 5. The robotic surgical system of claim 1,further comprising a proximity sensor to output a proximity signal tothe control circuit, wherein the control circuit is configured todetermine a distance between the first robotic arm and the secondrobotic arm based on the proximity signal.
 6. The robotic surgicalsystem of claim 1, wherein the control circuit is further configured tocause the first robotic arm and the second robotic arm to respectivelychange a first pivot position of the first robotic arm and a secondpivot position of the second robotic arm, wherein the first pivotposition and the second pivot position each maintain a respective pivotconfiguration relative to a first trocar and a second trocar.
 7. Therobotic surgical system of claim 6, wherein the respective change of thefirst pivot position and the second pivot position is based on a forcethreshold.
 8. A robotic surgical system for treating a patient, therobotic surgical system comprising: a first robotic arm configured tocontrol a surgical instrument extending therefrom, wherein the surgicalinstrument is configured to be positioned within a cavity of thepatient, and wherein the first robotic arm is attached to a surgicalplatform in a sterile zone; a second robotic arm configured to control asurgical device extending therefrom, wherein the surgical device isconfigured to pass through a natural orifice of the patient, and whereinthe second robotic arm is attached to the surgical platform in anon-sterile zone; and a control circuit communicatively coupled to thefirst and the second robotic arm, wherein the control circuit isconfigured to: determine a first position of the first robotic arm inthe sterile zone; determine a second position of the second robotic armin the non-sterile zone; and cause the first robotic arm and the secondrobotic arm to cooperatively interact to perform a surgical operationacross the sterile zone and the non-sterile zone.
 9. The roboticsurgical system of claim 8, wherein the surgical instrument is acircular stapler.
 10. The robotic surgical system of claim 9, whereinthe surgical device is configured to reposition tissue relative to thecircular stapler.
 11. The robotic surgical system of claim 8, furthercomprising a third robotic arm configured to control an ultrasonicsurgical instrument in the sterile zone.
 12. The robotic surgical systemof claim 8, wherein the surgical instrument is configured to resect afirst tissue of the patient in the sterile zone.
 13. The roboticsurgical system of claim 12, wherein the surgical device is configuredto move a second tissue of the patient in the non-sterile zone.
 14. Therobotic surgical system of claim 8, further comprising: a third roboticarm attached to the surgical platform; and a proximity sensor configuredto output a plurality of proximity signals to the control circuit,wherein the control circuit is configured to determine a plurality ofdistances between the first robotic arm, the second robotic arm, and thethird robotic arm based on the plurality of proximity signals.
 15. Arobotic device comprising: a first robotic arm configured to control asurgical instrument extending therefrom, wherein the surgical instrumentis configured to be positioned within a cavity of a patient, and whereinthe first robotic arm is positioned in a sterile zone; a second roboticarm configured to control a surgical device extending therefrom, whereinthe surgical device is configured to pass through a natural orifice ofthe patient, and wherein the second robotic arm is positioned in anon-sterile zone; and a control circuit communicatively coupled to thefirst and the second robotic arm, wherein the control circuit isconfigured to: cause the first robotic arm to change a position and anorientation of the first robotic arm based on movement of the patient;cause the second robotic arm to change a position and an orientation ofthe second robotic arm based on movement of the patient; and control thefirst robotic arm and the second robotic arm to cooperatively interactto perform a surgical operation across the sterile zone and thenon-sterile zone.
 16. The robotic device of claim 15, wherein: thesurgical instrument comprises a first communication module; the surgicaldevice comprises a second communication module to communicate with thesurgical instrument; and the control circuit is configured to controlthe cooperative interaction of the first robotic arm and the secondrobotic arm based on communication between the surgical instrument andthe surgical device.
 17. The robotic device of claim 15, wherein: thesurgical instrument is a circular stapler; and the surgical device is ananvil.
 18. The robotic device of claim 15, further comprising: a lockoutmechanism configured to prevent additional movement of the first roboticarm and the second robotic arm while the respective position andorientation of the first robotic arm and the second robotic arm ischanged.
 19. The robotic device of claim 15, wherein the respectivechange in position and orientation of the first robotic arm and thesecond robotic arm is based on a transverse force threshold of the firstrobotic arm and the second robotic arm.
 20. The robotic surgical systemof claim 1, wherein the adjustment of the platform position of thesurgical platform comprises at least one of: an adjustment of thesurgical platform from a horizontal position to a Trendelenburgposition; an adjustment of an incline of the surgical platform; anadjustment of a decline of the surgical platform; or a rotationaladjustment of the surgical platform.